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Prime Therapeutics Compliance Manager - MA-PD and PDP plans - Remote in Des Moines, Iowa

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Compliance Manager - MA-PD and PDP plans - Remote

Job Description

The Compliance Manager works closely with designated business areas, Legal, and other internal partners to identify changing laws and regulations, accreditation standards, and client contractual compliance obligations, interpret the impact, and manage solutions for designated business areas. This position serves as a consultant to internal stakeholders regarding the development, implementation and monitoring of compliance initiatives and helps to create a culture of compliance throughout the organization.

Responsibilities

  • Executes compliance procedures and enforces policy governance across the organization and assigned function to validate regulatory reporting requirements are met and that business operations are aligned with applicable regulatory guidance; designs, develops, implements, conducts and maintains effective compliance, risk, assessment, vendor and ethics awareness processes, audits, work plans and communications based on business need and risk ranking methodology

  • Supports the prompt and thorough investigation of reported compliance-related issues, partnering with Legal and HR as appropriate

  • Represents the compliance organization and at times, Prime, as a primary contact on contracts or significant enterprise projects; collaborates with and represents the interests of key internal and external stakeholders

  • Serves as a consultant to management on major matters pertaining to policies, plans and objectives and provides Subject Matter Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid, Corporate Compliance, Compliance Assessment or Services etc.)

  • Develop and track useful metrics to assist leadership in preparing periodic reports demonstrating effectiveness of function

  • Manage the preparation, implementation and maintenance of compliance standards and procedures (Standard Operating Procedures, Desk Top Procedures, etc.) and review applicable operations teams’ documentation; develop regulatory monitoring and response strategies for regulatory changes or new laws/regulations to assist designated business area with regulatory change management efforts

  • Provide direct, or indirect leadership to other compliance professionals, consistently role modeling Prime’s employee and leadership expectations

  • May oversee and support audit action plans and/or corrective action plans for the designated business area; design remedies and support the business in implementing, tracking and completing their plans as required

  • May evaluate overall compliance training requirements and develop and implement response plans and training solutions to support a culture of compliance across the enterprise; if supporting corporate compliance efforts, may manage annual conflict of interest and code of conduct programs

  • Other duties as assigned

Minimum Qualifications

  • Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required

  • 6 years of progressive work experience in legal or compliance related roles for a healthcare or Pharmacy Benefit Management organization, or within a highly regulated industry, including experience with Medicare, Medicaid, and the Affordable Care Act (ACA)

  • Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

  • Exceptional written and oral communication skills

  • Demonstrated ability to apply critical thinking skills to proactively identify issues and problem solve through the most complex compliance situations

  • Experience assessing training requirements and developing, delivering and assessing effective enterprise training programs through a variety of channels

  • Expert level understanding of effective compliance program principles, concepts, practices and standards; full breadth of knowledge around industry best practices and challenges and experience developing new concepts, techniques, standards and programs to support an organization’s compliance priorities

  • Ability to effectively interpret and present complex information to a wide variety of audiences

  • Ability to establish rapport and effectively influence at all levels within an organization

  • Enhanced organizational skills with the ability to effectively work on multiple projects simultaneously

  • If working within Licensing, previous experience maintaining, tracking, renewing and submitting applications for licensure

Preferred Qualifications

  • Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance Professional (CHC)

  • Certified Project Management Professional (PMP)

  • Advanced degree in related area of study, such as Juris Doctor

  • Leadership experience

  • Working knowledge of NCQA and/or URAC accreditation standards

Minimum Physical Job Requirements

  • Ability to travel up to 20% of the time

  • Constantly required to sit, use hands to handle or feel, talk and hear

  • Frequently required to reach with hands and arms

  • Occasionally required to stand, walk and stoop, kneel, and crouch

  • Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

  • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

  • Reports to Director or Senior Director in the Compliance department

Potential pay for this position ranges from $82,200.00 - $123,400.00 based on location, experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

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