Regulatory Operations Leader – Health Plan Compliance

Presbyterian Healthcare Services; Albuquerque (NM); On-site; USD 76,000 - 129,000; Full time

Job summary

Presbyterian Healthcare Services in Albuquerque, NM seeks a Regulatory Operations Manager to lead regulatory activities across commercial, Medicaid and Medicare Advantage insurance products, guiding the interpretation and application of applicable laws.

The role coordinates responses to regulatory inquiries, performs analyses, and communicates changes to business owners to ensure compliant operations and risk reduction.

Qualifications

• Bachelor's degree required with 3–5 years in health plan management or regulatory/compliance.
• Experience interpreting and applying state/federal health insurance regulations.
• Ability to manage multiple regulatory tasks and coordinate with legal teams.

Responsibilities

• Serve as regulatory liaison to ensure compliance with contractual and regulatory requirements.
• Support inquiries, reporting, and audits related to insurance products.
• Track federal/state laws and present changes at internal meetings.
• Assist with CAP elements, policy development, and training as needed.

Skills

Regulatory compliance

Health plan management

Regulatory/legal experience

Cross-functional collaboration

Influence without direct authority

Education

Bachelor's degree

Job description

Presbyterian Healthcare Services in Albuquerque, NM seeks a Regulatory Operations Manager to lead regulatory activities across commercial, Medicaid and Medicare Advantage insurance products, guiding the interpretation and application of applicable laws.

The role coordinates responses to regulatory inquiries, performs analyses, and communicates changes to business owners to ensure compliant operations and risk reduction.