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Job Posting Title
Manager, Compliance - Remote
Job Description
The Compliance Manager works closely with designated business areas, Legal, and other internal partners to identify changing laws and regulations, accreditation standards, and client contractual compliance obligations, interpret the impact, and manage solutions for designated business areas. This position serves as a consultant to internal stakeholders regarding the development, implementation and monitoring of compliance initiatives and helps to create a culture of compliance throughout the organization.
Responsibilities
- Executes compliance procedures and enforces policy governance across the organization and assigned function to validate regulatory reporting requirements are met and that business operations are aligned with applicable regulatory guidance; designs, develops, implements, conducts and maintains effective compliance, risk, assessment, vendor and ethics awareness processes, audits, work plans and communications based on business need and risk ranking methodology.
- Supports the prompt and thorough investigation of reported compliance-related issues, partnering with Legal and HR as appropriate.
- Represents the compliance organization and at times, Prime, as a primary contact on contracts or significant enterprise projects; collaborates with and represents the interests of key internal and external stakeholders.
- Serves as a consultant to management on major matters pertaining to policies, plans and objectives and provides Subject Matter Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid, Corporate Compliance, etc.).
- Develops and tracks useful metrics to assist leadership in preparing periodic reports demonstrating effectiveness of the compliance function.
- Manages the preparation, implementation, and maintenance of compliance standards and procedures (Standard Operating Procedures, Desk Top Procedures, etc.) and reviews applicable operations teams’ documentation; develops regulatory monitoring and response strategies for changes or new laws/regulations.
- Provides leadership to other compliance professionals, role modeling Prime’s employee and leadership expectations.
- May oversee and support audit and corrective action plans for the designated business area; designs remedies and supports the business in implementing, tracking, and completing their plans.
- Evaluates compliance training requirements and develops and implements training programs to support a culture of compliance; may manage conflict of interest and code of conduct programs.
- Other duties as assigned.
Minimum Qualifications
- Bachelor’s degree in business, healthcare, or related area, or equivalent experience; HS diploma or GED required.
- 6 years of progressive experience in legal or compliance roles within healthcare or a highly regulated industry, including experience with Medicare, Medicaid, and the ACA.
- Must be eligible to work in the US without sponsorship.
Additional Qualifications
- Exceptional communication skills.
- Critical thinking and problem-solving skills in complex compliance situations.
- Experience developing and delivering enterprise training programs.
- Expertise in compliance program principles, standards, and practices.
- Ability to interpret and present complex information effectively.
- Ability to influence at all organizational levels.
- Strong organizational skills for managing multiple projects.
Preferred Qualifications
- Certified Compliance and Ethics Professional (CCEP) or Healthcare Compliance Professional (CHC).
- Experience in healthcare, insurance, or PBM sectors.
- Advanced degrees like JD, MHA, MPA.
- Leadership experience.
Minimum Physical Job Requirements
- Travel up to 20%.
- Constantly sit, use hands, talk, hear.
- Frequently reach with hands and arms.
- Occasionally stand, walk, stoop, kneel, crouch.
- Occasionally lift up to 25 pounds.
- Specific vision abilities required.
Reporting Structure
- Reports to Director or Senior Director in Compliance.