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Manager, Compliance Assessment The candidate will direct compliance risk assessment management process. Drive development of the annual compliance assessment work plan based upon risk ranking methodology. Manage the compliance assessment team by providing thoughtful leadership, setting clear goals and expectations, and helping to maximize the contributions of each team member. Provide support in regulatory audits, client delegation audits, vendor compliance oversight audits, and accreditation surveys. Develop and track useful metrics to assist leadership in preparing periodic reports demonstrating effectiveness of function. Assist in the management of Corrective Action Plans (CAPs); validate remediation efforts prior to appropriate closure. Support the prompt and thorough investigation of reported compliance-related issues, partnering with Legal and HR as appropriate. Maintain awareness of industry oversight expectations, changes and enforcement trends. Forge and maintain positive working relationships with business owners, senior management and compliance colleagues. May evaluate overall compliance training requirements and develop and implement response plans and training solutions to support a culture of compliance across the enterprise. Other duties as assigned. Bachelor’s degree in business or healthcare, or JD degree, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required. Should have 7+ years of legal or compliance related work experience for a healthcare or PBM organization, or a combination of 10 years of experience working with healthcare claims, Medicare/Medicaid, federal/state government or experience working within a highly regulated industry. Should preferably have strong working knowledge of Medicare Part D, Medicaid, and/or Health Insurance Marketplace guidance. Working knowledge of NCQA and/or URAC accreditation standards is a plus. Should preferably be Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC) or Certified Internal Auditor (CIA) designation.
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