Job Overview
Location
Remote
Job Type
Full-time
Category
HR & Recruiting
Date Posted
May 5, 2026
Full Job Description
📋 Description
- • The Senior Regulatory Specialist – Pharmacy ensures compliance with CMS, State DOH, and other regulatory requirements within Healthfirst's Pharmacy and Dental departments and delegated vendors, playing a critical role in maintaining adherence to federal and state healthcare regulations.
- • Day-to-day responsibilities include monitoring incoming regulations from CMS, DOH, and OMIG; sharing regulatory guidance with the Pharmacy department; coordinating RRP review team meetings; documenting attendance and minutes; analyzing pharmacy and medical claims data to identify potential RRP candidates; managing the RRP roster; processing referrals, notifications, and restriction changes; triaging RRP Inbox requests; assisting with state audits; identifying process gaps; and supporting corrective action plans.
- • Healthfirst is a mission-driven healthcare organization committed to improving access to quality care, particularly for underserved communities, with a strong focus on regulatory compliance and operational excellence in managed care.
- • In this role, the individual will develop deep expertise in Medicaid and Medicare regulatory frameworks, gain experience in healthcare compliance operations, strengthen analytical and coordination skills, and contribute to fraud, waste, and abuse prevention initiatives while supporting organizational integrity and audit readiness.
🏖️ Benefits
- • Medical, dental, and vision coverage
- • Incentive and recognition programs
- • Life insurance
- • 401k contributions
- • Competitive hiring range: $83,100 - $120,360 (Greater NYC) or $73,400 - $109,225 (other approved locations)
Skills & Technologies
About Healthfirst, Inc.
Healthfirst is a New York-based health insurance provider offering affordable, comprehensive plans to individuals, families, and seniors. For over 30 years, the company has delivered diverse options, including Essential Plans, Medicaid Managed Care, Child Health Plus, Marketplace plans, and specialized Medicare Advantage and Long-Term Care solutions. Healthfirst offers benefits like medical, prescription drug, dental, and vision coverage. Notably, Healthfirst maintains the only 5-star rated Essential Plan in New York for two consecutive years, solidifying its position as a trusted leader in accessible community healthcare.
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