Prescription Drug Plan Compliance Consultant - Remote
Prescription Drug Plan Compliance Consultant - Remote Location:
Remote Work Work Type:
Full Time Regular Job No:
502452 Categories:
Legal/Compliance Application Closes:
Open Until Filled As our PDP Compliance Consultant, you'll be responsible for overseeing, coordinating, and conducting internal and delegated entity audits for Medicare and health related products.
You'll provide recommendations to our business areas to ensure compliance and mitigate risk.
This is a small, 2-person team with high visibility to our Chief Compliance & Ethics Officer.
WHAT WE CAN OFFER YOU:
Base salary $80,000-$90,000, plus annual bonus opportunity.
Remote opportunity.
401(k) plan with a 2% company contribution and 6% company match.
Regular associates working 40 hours a week can earn up to 15 days of vacation each year.
Regular associates receive 9 paid holidays in 2023.
Regular associates are provided sick leave through the use of personal time.
Associates working 40 hours a week can receive up to 56 hours of personal time in 2023, prorated based on the start date.
WHAT YOU'LL DO:
Provide guidance, consultation and support to the Company's Medicare and Health related business area and its products as it relates to compliance activities and accountabilities.
Provide technical assistance and training to business units within the Plan including external entities.
Direct and facilitate audits and monitoring reviews of internal business departments and delegated entities involved in the delivery and/or administration of Medicare plans and Health related products for compliance with the Center for Medicare and Medicaid Services (CMS).
Assist in managing the detection, prevention, and correction of fraud, waste and abuse for the Company's Medicare and Health related Plan(s).
Develop and update compliance audit instruments and protocols to align with CMS and other regulatory requirements.
Review and update policy and procedures and standard operating procedures.
Prepare and present reports based on internal audit results to senior management committees, including recommendations for corrective action.
Oversee and ensure resolution of findings and maintains records of audits and follow-up of actions taken.
Communicate with CMS and other regulatory agencies to clarify requirements, address reporting and filing issues.
Provide interpretation of Medicare related laws and regulations and recommendations to help set company direction across business units.
Manage dissemination of CMS and other regulatory requirements/directives and communications to applicable business areas and maintains adherence to Compliance Monitoring Calendar.
WHAT YOU'LL BRING:
Extensive background and experience with CMS requirements and regulations related to Medicare and Health products related operations and compliance, with at least 3 years of experience with Managed Care Organization or Health Plan.
Deep knowledge of relevant Medicare regulatory resources, including knowledge of and experience in Medicare and health related products compliance and risk management monitoring practices and methodologies.
Demonstrated customer focus with success in meeting customer requirements in a fast paced, multi-faceted, highly regulated and diverse environment.
Ability to work efficiently in pressure situations and demonstrate a high level of flexibility through rapid changes, while handling multiple and diverse complex assignments/projects simultaneously.
Strong knowledge of and experience in interpreting industry laws, regulations, legal opinions, and guidance related to Medicare and health related products with the ability to identify, interpret and apply regulatory related issues and activities.
Ability to analyze, interpret and utilize significant data to make sound business decisions; ability to evaluate current compliance situations, monitor controls, identify a path to solution, and execute a plan to ensure compliance.
You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.
VALUABLE
Experience:
Demonstrated experience and knowledge of Managed Care payment methodologies.
Knowledge of Prescription Drug Plan, CMS program, and/or State Department of Insurance audits.
Health Care Compliance Certification (e.
g.
CHC, CHPC, CHRC).
We value diverse experience, skills, and passion for innovation.
If your experience aligns with the listed requirements, please apply! After applying, for inquiries about your application or the hiring process, please call our helpline at 800-365-1405, option 2.
Help:
8003651405 Apply Now Recommended Skills Administration Auditing Communication Consulting Content Management Corrective And Preventive Action (Capa) Estimated Salary: $20 to $28 per hour based on qualifications.
Remote Work Work Type:
Full Time Regular Job No:
502452 Categories:
Legal/Compliance Application Closes:
Open Until Filled As our PDP Compliance Consultant, you'll be responsible for overseeing, coordinating, and conducting internal and delegated entity audits for Medicare and health related products.
You'll provide recommendations to our business areas to ensure compliance and mitigate risk.
This is a small, 2-person team with high visibility to our Chief Compliance & Ethics Officer.
WHAT WE CAN OFFER YOU:
Base salary $80,000-$90,000, plus annual bonus opportunity.
Remote opportunity.
401(k) plan with a 2% company contribution and 6% company match.
Regular associates working 40 hours a week can earn up to 15 days of vacation each year.
Regular associates receive 9 paid holidays in 2023.
Regular associates are provided sick leave through the use of personal time.
Associates working 40 hours a week can receive up to 56 hours of personal time in 2023, prorated based on the start date.
WHAT YOU'LL DO:
Provide guidance, consultation and support to the Company's Medicare and Health related business area and its products as it relates to compliance activities and accountabilities.
Provide technical assistance and training to business units within the Plan including external entities.
Direct and facilitate audits and monitoring reviews of internal business departments and delegated entities involved in the delivery and/or administration of Medicare plans and Health related products for compliance with the Center for Medicare and Medicaid Services (CMS).
Assist in managing the detection, prevention, and correction of fraud, waste and abuse for the Company's Medicare and Health related Plan(s).
Develop and update compliance audit instruments and protocols to align with CMS and other regulatory requirements.
Review and update policy and procedures and standard operating procedures.
Prepare and present reports based on internal audit results to senior management committees, including recommendations for corrective action.
Oversee and ensure resolution of findings and maintains records of audits and follow-up of actions taken.
Communicate with CMS and other regulatory agencies to clarify requirements, address reporting and filing issues.
Provide interpretation of Medicare related laws and regulations and recommendations to help set company direction across business units.
Manage dissemination of CMS and other regulatory requirements/directives and communications to applicable business areas and maintains adherence to Compliance Monitoring Calendar.
WHAT YOU'LL BRING:
Extensive background and experience with CMS requirements and regulations related to Medicare and Health products related operations and compliance, with at least 3 years of experience with Managed Care Organization or Health Plan.
Deep knowledge of relevant Medicare regulatory resources, including knowledge of and experience in Medicare and health related products compliance and risk management monitoring practices and methodologies.
Demonstrated customer focus with success in meeting customer requirements in a fast paced, multi-faceted, highly regulated and diverse environment.
Ability to work efficiently in pressure situations and demonstrate a high level of flexibility through rapid changes, while handling multiple and diverse complex assignments/projects simultaneously.
Strong knowledge of and experience in interpreting industry laws, regulations, legal opinions, and guidance related to Medicare and health related products with the ability to identify, interpret and apply regulatory related issues and activities.
Ability to analyze, interpret and utilize significant data to make sound business decisions; ability to evaluate current compliance situations, monitor controls, identify a path to solution, and execute a plan to ensure compliance.
You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.
VALUABLE
Experience:
Demonstrated experience and knowledge of Managed Care payment methodologies.
Knowledge of Prescription Drug Plan, CMS program, and/or State Department of Insurance audits.
Health Care Compliance Certification (e.
g.
CHC, CHPC, CHRC).
We value diverse experience, skills, and passion for innovation.
If your experience aligns with the listed requirements, please apply! After applying, for inquiries about your application or the hiring process, please call our helpline at 800-365-1405, option 2.
Help:
8003651405 Apply Now Recommended Skills Administration Auditing Communication Consulting Content Management Corrective And Preventive Action (Capa) Estimated Salary: $20 to $28 per hour based on qualifications.
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