Mgr Compliance

Amerihealth Caritas•,

4d•Remote

About The Position

At the direction and assistance of the Compliance Director, the Compliance Manager is responsible for supporting and enhancing the organization’s compliance program through oversight, monitoring, reporting, and partnership with key stakeholders across lines of business. This role oversees the organization’s compliance for Pharmacy and PBM oversight. The role will work closely with all plan market, pharmacy and compliance leadership teams to maintain an effective compliance program with measurable outcomes based on data. The Compliance Manager performs review and synthesis of operational metrics and delivers actionable insights on compliance trends, emerging risks, and control performance. In addition, the role will focus heavily on all elements of an effective compliance program within the pharmacy and PBM delegation oversight.

Requirements

Bachelor’s Degree in Business, Social Science, or relevant field required. Legal background helpful. Additional experience and background are considered in lieu of a degree.
3+ years in a managed healthcare government products (preferably pharmacy or PBM) environment required.
A minimum of 1 year of supervisory experience is required.
Experience creating reporting and monitoring dashboards for transparency to daily operations through Executive Leadership.
Experience being a plan representative in regulatory audits and maintaining audit readiness.
Ability to create and maintain compliance programs as needed to support multiple lines of business.
Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.
Self-motivated with demonstrated project management skills.

Nice To Haves

Experience in the areas of compliance and delegation oversight preferred.
Knowledge of compliance concepts and practices (prevention, detection, and correction) is preferred
Certified in Healthcare Compliance preferred.

Responsibilities

Oversee the development and improvement of Pharmacy and PBM Delegation oversight and compliance.
Support and/or manage compliance investigations through resolution, including issue triage, fact gathering, documentation, and communication of outcomes.
Develop, maintain, and enhance compliance dashboards and reporting, ensuring accurate, timely, and actionable insights for stakeholders.
Analyze and synthesize operational and compliance metrics; translate findings into clear reporting for leadership and business partners.
Partner with key stakeholders across lines of business to implement compliance requirements, remediate issues through corrective action, and strengthen controls.
Prepare and maintain compliance documentation, including procedures, workflows, evidence of monitoring, and reporting artifacts.
Contribute to compliance program governance, including periodic reporting, committee/leadership updates, and support for compliance risk assessment.