Regulatory Policy Analyst

Summary

Join Integrity Management Services, Inc. (IntegrityM) as a Regulatory/Policy Analyst and leverage your expertise in federal, state, and commercial payer policies to support the development of artificial intelligence and machine learning (AI/ML) models. You will translate complex regulatory frameworks into actionable insights, ensuring model integrity and audit readiness. This role bridges regulatory compliance, clinical expertise, and data science. Key responsibilities include monitoring and interpreting healthcare regulations, translating regulatory language into actionable insights for AI/ML model design, and providing clinical and regulatory input for model training, testing, and validation. You will also design and deliver internal training on regulatory frameworks. The ideal candidate possesses a Bachelor’s degree in a related field, minimum 3 years of clinical experience as a registered nurse, and at least 6 years of experience in regulatory compliance or a related area. Strong analytical and communication skills are essential.

Requirements

• Bachelor’s degree in Nursing, Health Policy, Healthcare Administration, or a related field
• Minimum of 3 years of clinical experience as a registered nurse
• At least 6 years of experience in regulatory compliance, healthcare policy analysis, medical auditing, or appeals within healthcare settings
• Demonstrated experience interpreting and applying federal and state healthcare regulations and payer policies
• Strong analytical skills and experience working with cross-functional teams, particularly in data science, informatics, and quality assurance
• Excellent written and verbal communication skills; ability to translate technical and regulatory language into accessible guidance
• High attention to detail, with the ability to manage competing priorities in a fast-paced environment

Responsibilities

• Monitor, analyze, and interpret evolving federal, state, and commercial healthcare regulations, coding guidance, and policy updates
• Translate complex regulatory language into clear, actionable insights to inform AI/ML model design and application
• Act as a regulatory policy tie-breaker and escalation resource for model development and review discussions
• Provide clinical and regulatory input to support the training, testing, and validation of AI/ML models, ensuring alignment with coding and policy standards
• Contribute to quality assurance and model performance evaluation efforts, including inter-rater reliability (IRR) assessment and policy-level consensus activities
• Assist in the development of compliance safeguards and regulatory checkpoints within the model lifecycle
• Design and deliver internal training, level-setting workshops, and documentation to ensure stakeholder understanding of regulatory frameworks
• Serve as a knowledge resource for audit-readiness and policy compliance during external reviews or model validations

Preferred Qualifications

• Active Registered Nurse (RN) license preferred
• Or other clinical specialties
• Master's Degree in Nursing, Health Policy, Healthcare Administration, or a related field preferred
• Familiarity with CMS regulations, HEDIS, NCQA, or other performance measurement frameworks
• Experience with commercial/private insurance, Medicare Advantage (Part C) policy and/or CMS program integrity initiatives
• Prior involvement in AI/ML model development, clinical data analytics, or technology-driven healthcare tools
• Familiarity with healthcare data structures such as claims, EHR, and HEDIS metrics
• Understanding of algorithmic bias and mitigation practices in healthcare modeling
• Knowledge of machine learning concepts, model governance, or compliance documentation in digital health or health IT settings