Anticipated End Date:

2024-10-14

Position Title:

PBM Compliance Manager (Accreditation)

Job Description:

JR128086 PBM Compliance Manager (Accreditation)

Responsible for coordinating pharmacy accreditation and compliance activities and initiatives across the PBM and the enterprise by maintaining department approved accreditation, regulatory and legislative compliance plan and implementing effective internal controls.

Location: This position will work a hybrid model (remote and office) and must live within 50 miles of one of our Pulse Point office locations

How will you make an impact:

• Identifies, monitors, revises and tracks business unit processes and implementing procedures to ensure compliance with all related measures.

• Identifies potential risks associated with PBM activities and ensures procedures are in place to minimize risks.

• Partners with business units to ensure compliance with all accreditation statutory and regulatory requirements.

• Participates as compliance subject matter expert on all mandated projects; achieves business operational compliance with all related measures relative to HIPAA and SOX and Privacy and Security Office initiatives.

• Conducts, directs, leads and facilitates all activities related to Internal and External (Regulatory and Client) audits and responds to findings.

• Performs high level regulatory research, develops strategic plans and pro-actively anticipates business needs and requirements.

• Develops and implements training and communication plans; manages and leads scheduled and ad-hoc compliance projects; provides and delivers compliance consultation services to the business unit.

Minimum requirements:

• Requires a BA/BS and minimum of 6 years’ experience; or any combination of education and experience, which would provide an equivalent background. 

Preferred Skills, Capabilities, and Experiences:

• MS/MBA or field related professional designation preferred.

• Travels to worksite and other locations as necessary.

• Experience with NCQA and/or URAC (URAC PBM preferred) accreditation, including preparation for accreditation survey activities and delegation oversight is highly preferred.

• 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.

• PBM Operations experience is highly preferred.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

FRD > Compliance

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

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.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.