PBM Compliance Manager (Accreditation) at Elevance Health in Mason, Ohio

Job Description:

JR128086 PBM Compliance Manager (Accreditation)



Responsible for coordinating pharmacy accreditation and compliance activities and initiatives across the PBM and the enterprise by maintaining department approved accreditation, regulatory and legislative compliance plan and implementing effective internal controls.



Location: This position will work a hybrid model (remote and office) and must live within 50 miles of one of our Pulse Point office locations



How will you make an impact:

• Identifies, monitors, revises and tracks business unit processes and implementing procedures to ensure compliance with all related measures.
  
  


• Identifies potential risks associated with PBM activities and ensures procedures are in place to minimize risks.
  
  


• Partners with business units to ensure compliance with all accreditation statutory and regulatory requirements.
  
  


• Participates as compliance subject matter expert on all mandated projects; achieves business operational compliance with all related measures relative to HIPAA and SOX and Privacy and Security Office initiatives.
  
  


• Conducts, directs, leads and facilitates all activities related to Internal and External (Regulatory and Client) audits and responds to findings.
  
  


• Performs high level regulatory research, develops strategic plans and pro-actively anticipates business needs and requirements.
  
  


• Develops and implements training and communication plans; manages and leads scheduled and ad-hoc compliance projects; provides and delivers compliance consultation services to the business unit.
  
  

• Requires a BA/BS and minimum of 6 years' experience; or any combination of education and experience, which would provide an equivalent background.
  
  

• MS/MBA or field related professional designation preferred.
  
  


• Travels to worksite and other locations as necessary.
  
  


• Experience with NCQA and/or URAC (URAC PBM preferred) accreditation, including preparation for accreditation survey activities and delegation oversight is highly preferred.
  
  


• Monitoring performance metrics experience is an asset.
  
  


• Management and maintenance of Policies and Procedures is an asset.
  
  


• Coordination of committee meetings and minutes is an asset.
  
  


• SharePoint set up and maintenance experience is an asset.
  
  


• PBM Operations experience is highly preferred.