Sr. Director, Medical Pharmacy Compliance - Remote

Company: Prime Therapeutics
Location: Baton Rouge
Posted on: January 24, 2023

Job Description:

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 TitleSr. Director, Medical Pharmacy Compliance - RemoteJob Description SummaryThis position is responsible for assisting with the implementation and administration of the Magellan Pharmacy Compliance Program.Job Description

• Assists with the implementation of the Magellan Pharmacy Compliance Program, and educates the management team and staff about compliance and the appropriate components of the compliance program and the Office of Inspector General (OIG) Work Plan.
• Provides guidance to operations units in the development and implementation of policies and procedures relevant to Magellans Medicare and Pharmacy Benefit Management (PBM) Services.
• Provides regular reports to the VP Pharmacy and Medicare Compliance Officer regarding the effectiveness of specific components of the Magellan Rx Compliance Program including remediation efforts and monitoring of corrective action plans.
• Implements appropriate program controls to prevent, detect, and correct potential issues of fraud, waste and abuse.
• Reviews operational policies and procedures to ensure compliance with CMS regulations and state and federal laws.
• Responsible for organizational compliance with HPMS notices, CMS and regulatory guidance, as appropriate.
• Provides guidance in response to operational compliance questions/concerns.
• Provides consultative leadership and directs efforts to communicate compliance program components, including training and education materials designed to promote understanding of compliance elements, regulations and laws, and consequences of non-compliance.
• Assists with the development and implementation of a metrics program to monitor processes of internal operations and First Tier, Downstream and Related Entities (FDRs) for compliance with applicable CMS regulations, guidance and appropriate federal and state laws.
• Reviews potential issues of non-compliance, report to Medicare Compliance Officer and coordinate investigation, remediation and provides appropriate guidance to operational areas.Responsibilities
  • 8+ years Healthcare Compliance experience with extensive experience with Medicare products, including Medicare Part D.
  • Strong verbal and written communication skills.
  • Working knowledge Microsoft Office Product Suite.Work ExperienceWork Experience - Required:Compliance, Medicare, Medicare Part D (MedD), SupervisoryWork Experience - Preferred:EducationEducation - Required:BachelorsEducation - Preferred:CertificationsCertifications - Required:Certifications - Preferred:Potential pay for this position ranges from $93,955.00 - $159,725.00 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 (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.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. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.

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