Regulatory Operations Analyst III - Medicaid

Position

Purpose:

Reviews, interprets and summarizes proposed and enacted legislation and regulatory updates to the business as a subject matter expert on various complex topics. Performs state or federal policy research and regulatory change monitoring with a goal of achieving formal regulatory approval of assigned products.

Key Details: This role is remote for candidates located in the State of Oregon only with some potential travel to Salem.

• Identifies, analyzes and interprets proposed or enacted legislation related to assigned product at the federal and state level and communicates findings to impacted departments. Independently performs risk assessments, including impact to business applications and downstream output. Maintains database and other reference materials related to legislative and regulatory issues and compliance.
• Performs comprehensive, complex regulatory analysis, including the review, summarization and dissemination of key regulatory updates and changes related to assigned product rules and regulations at the state and/or federal level. Leads regulatory interpretation related to assigned product rules and regulations and the assigned product explaining concepts clearly and adapting language and presentation based on audience level. Provides advice to business as new regulations emerge.
• Tracks proposed changes to Oregon Administrative Rules (OAR), keeping subject matter experts (SMEs) updated, and collecting feedback throughout the process. It includes engaging in Rule Advisory Committees (RACs), supporting the submission of written feedback to the Oregon Health Authority (OHA), and acting as the business owner for the RLI (Regulatory Legislation Implementation) process.
• Supports the end-to-end process for the annual contract restatement, serving as the business owner. This includes monitoring all changes from the initial proposal through contract finalization and implementation, attending related meetings, collaborating with the project manager to track implementation status, and identifying and escalating risks to the Executive Sponsor. Additionally, it involves analyzing contract amendments as they occur throughout the year.
• Supports Oregon Health Plan (OHP) contractor work groups includes attending key meetings, sharing topics in advance, and distributing information afterward. The responsibilities also involve responding to Requests for Information (RFIs) resulting from these meetings and bringing SMEs together as needed to discuss pertinent topics.
• Supports monthly Division of Financial Regulation (DFR) meetings by attending, organizing follow-ups, and acting as the primary contact for rules, bulletins, and expectations. This includes managing communications and ensuring compliance with regulatory requirements.
• Assesses and analyzes objections related to regulatory interpretation and leads drafting of appropriate responses which are provided to regulators related to impacted filings. Partners on response with cross-functional partners as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

• Demonstrated ability to build and maintain effective working relationships with state regulators, particularly the Oregon Health Authority (OHA).
• Strong technical understanding of Medicaid policy, administrative rules, and regulatory guidance; prior experience working at or with OHA is a plus.
• High level of attention to detail and strong organizational skills to manage complex regulatory requirements and timelines.
• Ability to translate highly technical regulatory and policy language into clear, plain-language guidance and actionable recommendations for internal collaborators.
• Proven ability to thoughtfully and effectively advocate for regulatory clarifications or changes when appropriate.
• Strong compliance mindset, with experience ensuring organizational practices align with regulatory and contractual requirements.

Bachelor's Degree in Business, Communications, Healthcare, Political Science/Pre-Law or equivalent experience required. Master's Degree in a related field, Juris Doctorate degree may be considered in place of experience preferred. 4+ years experience in health insurance, legal, compliance or related field required. Experience reviewing regulations and providing interpretation using terms appropriate for the audience preferred. Experience in commercial health insurance and/or behavioral health managed care preferred.

Pay Range: $70,100.00 - $ per…