Network Regulatory Specialist

Regular
Exempt

GENERAL DESCRIPTION:
Supports regulatory compliance through audit readiness, regulatory reviews, corrective action plan management, and monitoring of provider network activities, including contracting, credentialing, and recredentialing. Responsible for monitoring and analyzing metrics, key performance indicators (KPIs), and operational data to identify trends, assess risks, and support adherence to federal, state, accreditation, contractual, and organizational requirements. Collaborate with cross-functional teams to prepare regulatory documentation, support issue resolution, and contribute to continuous improvement efforts that strengthen compliance, mitigate risk, and enhance the effectiveness and integrity of Network Management (NM).
ESSENTIAL FUNCTIONS:
•Serve as the primary liaison between NM and Compliance to coordinate the communication, assessment, and operational implementation of regulatory, accreditation, and contractual requirements impacting NM functions.
•Evaluate regulatory, accreditation,



and business requirement changes affecting provider network operations, conduct operational impact assessments, and coordinate readiness activities to support timely implementation.
•Identify, assess, and monitor operational, regulatory, and process risks within NM activities, including provider contracting, credentialing, and recredentialing, and recommend mitigation strategies.
•Prepare and present risk assessments, readiness status updates, corrective action progress, and operational findings to NM leadership and other internal stakeholders to support effective governance and decision making.
•Facilitate the development, implementation, and monitoring of corrective action plans resulting from audits, regulatory reviews, internal assessments, and identified operational risks to ensure timely and sustainable remediation.
•Provide guidance and consultation to NM teams regarding operational implications of regulatory and

📌 Network Regulatory Specialist (San Juan)
🏢 MCS Healthcare Holdings, LLC (MCS)
📍 San Juan