External Compliance Support Mgr II

Exemption Status:

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Summary:  The External Compliance Support (ECS) Manager manages and oversees compliance auditing activities conducted by external entities such as MedImpact’s clients, consultant auditors (hired by MedImpact clients), or regulatory authorities.   This position manages requests received from clients undergoing audits to support those regulatory audits.  The Manager supports compliance audits of MedImpact by its clients and regulatory bodies such as CMS, state departments of insurance, and others.   

Essential Functions and Responsibilities include the following: (other duties may be assigned)

• Collaborates with identified subject matter experts to ensure compliance audit activities are conducted effectively and efficiently. Ensures notification, scope, and timelines of scheduled compliance audits are appropriately communicated to organization.

• Coordinates support activities with internal operational areas.  Oversees remediation, including corrective action plans, for all audits under ECS management.  Maintains corporate records of materials provided and received in compliance audit support activities. 

• Evaluates compliance audit requests to determine scope, applicability, and impact on organization.  Reviews any applicable regulatory requirements and contractual requirements.  Advises the appropriate internal audit support members of any applicable regulatory, contractual requirements or previous corrective action pertinent to the compliance audit activity.

• Develops and maintains standard compliance auditing information on various topics that can be utilized by external entities performing compliance audits on MedImpact. 

• Develops and maintains guidelines of standard materials to support specific compliance auditing as requested by external entities.  Maintains corporate records of materials provided to support compliance auditing activities, including the specifications utilized to create data reports.

• Oversees and manages a formalized follow-up session with appropriate internal audit support members, and leadership as appropriate, including follow-up on findings (e.g., corrective action plans).  Works with affected areas to ensure findings are addressed and within stated timelines.

• Prepares and presents compliance audit findings, corrective actions, and other relevant information to leadership.

• Assists the Corporate Compliance Officer with compliance program initiatives as well as educates and trains employees.

• Assists with the accreditation efforts (URAC and others) as needed to include information gathering.  Ensures standards are met; supports compliance assurance efforts related to MedImpact and subsidiary organizations.   

• Maintains accurate and timely records in tools used for tracking and reporting.

• Identifies process gaps and potential areas for improvement in standard compliance audit activities, collaborates with leadership to convey potential solutions, and provides appropriate documentation.  

• Identifies knowledge gaps and collaborates with leadership to ensure information sharing, education and training is available as applicable, including the development of such training.

• Coordinates and manages compliance support activities (projects, audit protocols, audit types) with internal operational areas as directed by leadership.

• Evaluates variant audit requests and escalates appropriately to leadership with a written audit summary, status, and plan of action.

• Evaluates and determines how to meet expectations of the auditing entity while assessing risk to MedImpact and impacting client satisfaction and expectations. 

• Presents information and responds to questions from groups of managers, clients, internal customers, including generating compliance audit trends and activity numbers.

Education and/or Experience                                             

Bachelor’s degree in a related field (or equivalent combination of education and experience). Related experience required in the healthcare (or similar) industry conducting and/or participating in regulatory authority or third party audits.

Normally requires at least 5 – 8+ years’ related experience along with a good familiarity with Pharmacy Benefit Management.

Intermediate to advanced knowledge of MS Office (Word, Excel, Access, PowerPoint) and Outlook.  Ability to independently operate in C360.

Certificates, Licenses, Registrations

CHC, PMP, or CPhT (or any combination) preferred but not required.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.