Advisor, Network Compliance

Cardinal Health•Dublin, OH

About The Position

What Network and Payor Relations contributes to Cardinal Health The Advisor, Network Compliance plays a critical role in safeguarding the Pharmacy Services Administrative Organization’s (PSAO) network integrity by ensuring adherence to both PBM and PSAO contractual obligations and the compliance standards of its member retail pharmacy providers. This position involves monitoring, detailed investigation, and collaborative efforts to navigate complex regulatory landscapes and contractual agreements, ultimately mitigating risks and fostering a compliant pharmacy network.

Requirements

Strong understanding of PBM contracts, federal and state regulatory requirements impacting pharmacies and PBMs, and pharmacy operations.
Exceptional analytical, research, and problem-solving skills.
Demonstrated ability to manage multiple tasks, prioritize effectively, and work independently under general supervision.
Excellent written and verbal communication skills, with the ability to collaborate effectively with diverse internal and external stakeholders, including legal counsel, data analysts, PBM representatives, and member pharmacies.
Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects
May contribute to the development of policies and procedures
Works on complex projects of large scope
Develops technical solutions to a wide range of difficult problems
Solutions are innovative and consistent with organization objectives
Completes work; independently receives general guidance on new projects
Work reviewed for purpose of meeting objectives
May act as a mentor to less experienced colleagues

Nice To Haves

Bachelor's degree in a relevant field (e.g., Healthcare Administration, Business, Legal Studies) or equivalent practical experience, preferred
3-5 years of experience in compliance, PBM operations, pharmacy regulatory affairs, or a related healthcare field, preferred

Responsibilities

Serve as a Subject Matter Expert (SME) on PBM contract, Provider Manual, and relevant regulatory requirements pertinent to member pharmacies.
Develop and maintain resources to support internal understanding and ensure PSAO member pharmacies have access to essential compliance information.
Foster member compliance through various communication and support channels.
Conduct thorough investigations into potential PSAO member compliance issues, utilizing available data and information sources.
Collaborate with legal counsel to prepare and issue any official notices required.
Work with relevant partners to support investigations and ensure member adherence.
Serve as an SME on PBM contract terms, accessing internal resources for key terms and conditions.
Serve as an SME on PBM regulatory requirements (federal and state), staying informed about newly enacted legislation and maintaining internal knowledge bases.
Request and review recurring and ad hoc PBM compliance reporting, leveraging data and collaborating with analytics teams.
Collaborate with Managed Care teams on PBM inquiries, and accurately document, summarize, and escalate PBM non-compliance issues.

Benefits

Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
Medical, dental and vision coverage
Paid time off plan
Health savings account (HSA)
401k savings plan
Access to wages before pay day with myFlexPay
Flexible spending accounts (FSAs)
Short- and long-term disability coverage
Work-Life resources
Paid parental leave
Healthy lifestyle programs