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Company

EmpiRx Health · 5 hours ago

Senior Director of Compliance

United States

Full-time

Remote

Senior Level, Lead/Staff, Director/Executive

8+ years exp

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Health CareHospital

Growth Opportunities

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Responsibilities

Oversee departmental workflow procedures as they relate to regulatory compliance and keeping the company up-to-date regarding state/federal regulations and compliance obligations

Effectively translates regulatory guidance into streamlined operational processes to ensure compliance, at times with short notice

Develop and maintain working knowledge of rules, and regulations that relate to PBM and health plans, their interpretation, current trends and issues, and timelines for compliance

Tracks and disseminates laws and regulations that affect the organization's policies.

Complete gap analyses for compliance with additions and changes to the standards, rules, and regulations and assess potential organizational impact

Develop and oversee the Enterprise overall Policy & Procedure process, and update related policies and procedures to ensure adherence to rules and regulations relating to the business

Provide timely and effective annual training sessions to employees on policies and procedures.

Develop, direct and maintain responsibility for the corporation's compliance function and business ethics related to standard of conduct, including HIPAA privacy and security compliance

Lead and prepare investigations related to compliance and privacy issues in an accurate manner, notifying affected parties in a timely manner.

Oversee, execute and prepare the acquisition and maintenance of required licenses (PBM, TPA and UR), and certificates from appropriate state and federal entities on a timely manner. Maintain and track reporting on licensing to ensure appropriate filings are provided to state regulators.

Collaborate with clinical, data analytics and client team and other stakeholders as needed, to identify and initiate improvements to ensure compliance with existing and evolving federal and state rules and regulations

Provides real-time guidance to business units and subsidiaries related to multiple potential compliance issues

Oversees the development and operation of compliance monitoring and auditing (i.e., compliance assurance program)

Manages any investigations of alleged violations of law, policies and procedures, and the Company’s Code of Conduct and Conflict of Interest policies

Manage and assists in the development, tracking and completion of corrective action plan

Manages the Enterprise Accreditation processes, on-going requirements and the annual re-accreditation processes

Lead Audit function in conjunction with other stakeholders to ensure compliance

Participate in Enterprise leadership committees as indicated, including but not limited to Quality Management, Compliance, and others

Other ad hoc activities and projects as assigned

Qualification

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Compliance ManagementRegulatory CompliancePolicy DevelopmentHIPAA ComplianceHealthcare Compliance CertificationTraining DevelopmentProject Management

Required

Bachelor’s degree, Health Care, or related area of study required

8+ years of compliance related & management experience in the PBM/Health Plan environment. Candidates with other healthcare experience (health plans,) may be considered

Experience with broad spectrum PBM offerings and associated potential regulatory issues

Self-starter with the ability to define, coordinate and direct assignments of team members

Strength in leading and managing teams of compliance professionals working in a high growth business

Ability to translate complex regulatory issues and risks into understandable concepts the team and other individuals with non-legal backgrounds

Excellent interpersonal, collaborations, communication, (verbal and written) and presentation skills essential