Director, Medical Pharmacy Compliance - Remote

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

Director, Medical Pharmacy Compliance - Remote

Job Description Summary

This position is responsible for assisting with the implementation and administration of the Magellan Pharmacy Compliance Program.

Job Description

Job Description Summary

This 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 across all lines of business and all states for all clients regarding the compliance program

• Provides guidance to operations units in the development and implementation of policies and procedures relevant to Magellan's Medical Pharmacy Solutions programs regarding regulations and regulatory changes

• Provides regular reports to Medical Pharmacy Leadership and 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 Medical Pharmacy solutions programs.

• 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 Medical Pharmacy Leadership, Medicare Compliance Officer and coordinate investigation, remediation and provides appropriate guidance to operational areas.

Minimum Qualifications

• 5+ years regulatory affairs experience in pharmacy industry required

• Experience with specialty drugs

• UM/UR experience

• Process improvement /optimization experience

• Juris Doctor (preferred, but not required)

• Licensed Pharmacist (preferred)

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 Experience

Work Experience - Required:

Compliance, Medicare, Medicare Part D (MedD), Supervisory

Work Experience - Preferred:

Education

Education - Required:

Bachelors

Education - Preferred:

Certifications

Certifications - Required:

Certifications - Preferred:

Potential pay for this position ranges from $95,840.00 - $162,920.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (~~~/) 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 ~~~ or email ~~~.