Risk and Compliance Manager overseeing third - party risk control and compliance in finance. Collaborating with teams across different locations to establish effective risk management strategies.
About the role
- Manager overseeing licensing and regulatory compliance for Pharmacy Benefit Dimensions. Responsible for operational activities and ensuring adherence to quality management and accreditation standards.
Responsibilities
- Overseeing the daily operational activities of program strategies to support Pharmacy Benefit Dimension’s accreditations, certifications, licenses, and regulatory requirements
- Oversee reporting requests and the submissions necessary to support them
- Oversee the licensing vendor
- Oversee the policy and procedure process, and activities supporting PBD’s Quality Management Committee and Medicare Part D STAR measures
- Manage the licensing vendor relationship to ensure all reporting, information and supporting documentation is transmitted and necessary applications are filed and tracked ensuring all licenses are acquired and/or maintained
- Oversee the review of standards, regulations and legislation along with the development and implementation of processes and documentation for accreditation, certification, registration and/or licensing
- Oversee project teams and performance of preparation activities for accreditation, certification, registration and/or licensing submissions, mid-cycle audits and renewals
- Manage and lead periodic reviews and mock audits as necessary to ensure PBD is audit ready for accreditation renewals
- Manage the oversight of the Medicare Part D STAR measures dashboard, identify and communicate trends to ensure leadership is able to take appropriate operational action
- Manage the policy and procedure process, policy committee meetings and general daily activities to ensure adherence and provide prompt reporting of instances of actual or potential non-compliance
- Oversee reporting and remediation efforts for instances of non-compliance, including but not limited to corrective action plans and HIPAA privacy and security events.
Requirements
- Bachelor’s degree required
- An additional four (4) years of experience will be considered in lieu of degree
- Five (5) years of corporate/regulatory licensing, quality monitoring/reporting, or program/process management experience required
- Two (2) years of progressive leadership/management experience required
- Experience working with regulatory and accreditation agencies including but not limited to URAC, DOL and CMS and compliance, quality monitoring/reporting or program management preferred
- Experience with self-funded group health plans preferred
- Excellent organizational, time management, analytical and critical thinking skills
- Experience in the creation or review of policies, procedures, and reports
- Ability to assess controls needed to meet requirements, render decisions and troubleshoot issues
- Advanced PC and Microsoft Office applications skills required
- Excellent interpersonal, written and verbal communication skills.
Benefits
- First-class perks and benefits
- Generous paid time off
- Full range of benefits
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