Director of Compliance and Development
Director of Compliance and Development
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
Director of Compliance and Development
RIDC Park - Pittsburgh Pa
Grane PBMs Director of Compliance is responsible for ensuring that Grane PBM operates within all legal regulatory and contractual requirements. This role involves overseeing compliance programs managing audits and mitigating risks related to pharmacy benefits for PACE Medicare/Medicaid and other healthcare regulations.
Responsibilities
Key Responsibilities:
- Regulatory Compliance: Ensure adherence to federal and state laws including CMS (Centers for Medicare & Medicaid Services) regulations HIPAA ERISA and other applicable requirements.
- Audit Management: Oversee internal and external audits including those conducted by government agencies and PBM clients.
- Policy Development: Develop implement and update compliance policies procedures and training programs.
- Risk Management: Identify compliance risks and develop mitigation strategies to prevent violations and penalties.
- Contract Compliance: Ensure that Grane PBM agreements with health plans pharmacies and pharmaceutical manufacturers align with legal and regulatory standards.
- Investigations & Reporting: Conduct internal investigations related to potential compliance violations and report findings to senior leadership and regulatory agencies when required.
- Liaison with Regulators: Serve as the primary contact for regulatory agencies ensuring timely reporting and resolution of compliance issues.
- Duties as assigned.
Qualifications
Qualifications:
- 5 years of experience in PBM healthcare compliance or regulatory affairs.
- Strong knowledge of CMS regulations PACE Medicare Part D Medicaid and pharmacy benefit operations.
- Experience managing audits and working with legal and regulatory bodies.
- Excellent communication and leadership skills.
- Ability to analyze complex regulations and translate them into actionable policies.
eoe
fm0418
Required Experience:
Director
Employment Type
Full-Time
