The Compliance (UM) Lead conducts and summarizes compliance audits. The Compliance (UM) Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
The Compliance (UM) Lead collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. Ensures mandatory reporting completed. Advises executives to develop compliance strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Review new and revised compliance requirements to identify impacts to the Careplus pharmacy area.
Provide guidance and direction to the pharmacy business area and assist in review/revision of new and existing processes and policy to ensure compliance controls exist as well as having them appropriately documented.
Identify compliance metrics and monitor for compliance trends and risks.
Provide guidance and direction to the business area on creation of corrective actions, oversight, monitoring and/or auditing.
Maintain detailed knowledge of audit protocols & regulatory requirements impacting audits.
Facilitates and participates in related meetings and activities and serves as a compliance subject matter expert for the pharmacy line of business.
The role will be leading a team of two compliance professionals.
6+ years of experience working in a healthcare related agency (CMS, CDC, NIH, Health plans, etc.) to include compliance and/or auditing experience
Experience reading and interpreting technical documents
Excellent interpersonal, written, and oral communication skills; ability to interact effectively with multi-disciplinary team members and management in leading meetings or workgroups
Strong critical thinking, problem solving, and attention to detail skills
Self-motivated and independent with an ability to manage multiple priorities and work under pressure to meet deadlines
Comprehensive knowledge of all Microsoft Office applications
Prior experience leading people or projects
Have prior experience with and knowledge about Medicare Part D and/or Medicare Advantage
Experience interacting with governmental agencies
Bilingual (English and Spanish)
This role will oversee 2 direct reports
Scheduled Weekly Hours
Equal Opportunity Employer
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