PBM Compliance Manager

2 days ago

Mason, Ohio, United States Elevance Health Full time
PBM Compliance Manager Job Description

Job Summary: We are seeking a highly skilled PBM Compliance Manager to join our team at Elevance Health. The successful candidate will be responsible for coordinating pharmacy accreditation and compliance activities across the PBM and the enterprise.

Key Responsibilities:

  • Develop and implement effective internal controls to ensure compliance with accreditation, regulatory, and legislative requirements.
  • Identify potential risks associated with PBM activities and develop procedures to minimize risks.
  • Partner with business units to ensure compliance with accreditation, statutory, and regulatory requirements.
  • Participate as a compliance subject matter expert on mandated projects and achieve business operational compliance with related measures.
  • Conduct, direct, lead, and facilitate activities related to internal and external audits and respond to findings.
  • Perform high-level regulatory research, develop strategic plans, and proactively anticipate business needs and requirements.
  • Develop and implement training and communication plans, manage and lead scheduled and ad-hoc compliance projects, and provide compliance consultation services to the business unit.

Requirements:

  • Bachelor's degree in a related field and a minimum of 6 years of experience, or any combination of education and experience that would provide an equivalent background.
  • Preferred skills include experience with NCQA and/or URAC accreditation, including preparation for accreditation survey activities and delegation oversight.
  • 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.

About Elevance Health: Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work: At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes, and drive our shared success – for our consumers, our associates, our communities, and our business.

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