PRIMARY PURPOSE OF THE ROLE: The Regulatory Compliance Operations Liaison serve as a key coordination point between Clinical Operations, Legal, Compliance, Licensing, and business stakeholders to support alignment with regulatory, accreditation, and jurisdiction requirements. This role interprets regulatory updates and translates them into clear operational guidance, supports utilization review and clinical pharmacy compliance activities, coordinates audit and accreditation readiness, and helps ensure regulatory communications, documentation, appeals, complaints, and operational processes are accurate, consistent, and appropriately vetted.
ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE - Interprets regulatory updates and compliance guidance and translates requirements into clear, actionable direction for Clinical Operations, Utilization Review, Pharmacy Operations, and related business teams.
- Partners with operational leaders to assess workflows against established policies, procedures, jurisdictional requirements, and accreditation standards; identifies gaps and recommends process improvements. Supports implementation and communication of regulatory, accreditation, and compliance-related changes across assigned clinical programs
- Serves as a liaison between Utilization Review, Pharmacy Operations, Legal, Compliance, Licensing, Claims, and other stakeholders to ensure communications, processes, and responses are appropriately reviewed and aligned.
- Supports utilization review regulatory inquiries, including appeals, complaints, audit requests, and other regulatory responses; manages and triages the Utilization Review Compliance mailbox to ensure timely routing, tracking, follow-up, and response.
- Maintains documentation, tracking logs, audit trails, and centralized records to support regulatory readiness, compliance oversight, and operational accountability; identifies and escalates compliance, licensing, regulatory, audit, appeal, complaint, or documentation risks to appropriate leadership.
- Coordinates and supports state-level utilization review appeals in collaboration with Claims, Clinical Operations, Legal, Compliance, and other appropriate stakeholders. Leads or supports development and maintenance of regulatory correspondence, standard letter templates, SOPs, operational documentation, and compliance-related communications.
QUALIFICATIONSEducation & LicensingBachelor's degree from an accredited college or university preferred. Licenses as needed.
ExperienceSix (6) years of related experience or equivalent combination of education and experience required.
TAKING CARE OF YOU - Flexible work schedule.
- Referral incentive program.
- Opportunity to work in an agile environment.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
Work environment requirements opportunities may include -
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $75,000 - $90,000/year. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
