Compliance Manager

Elevance Health • Atlanta, GA

1d • Hybrid

About The Position

Compliance Manager

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member’s health. The Compliance Manager will be responsible for managing foundational and strategic compliance responsibilities with consistent excellence that supports the team and management. Ensures PBM is in compliance with state regulations and requirements.

How you will make an impact:
Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness. Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates. Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert. Conduct complex investigations, document findings, and ensure corrective actions are made. Interface with external clients, regulators, vendors, suppliers, internal stakeholders, and high level management.

Requirements

• Requires a BA/BS and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• MS/MBA/JD or professional designation preferred.
• Compliance experience within a Pharmacy Benefit Manager (PBM) to include experience with PBM Regulatory Reporting preferred.
• Experience in monitoring and interpreting state and federal laws for Medicaid and Commercial related to impacts to Pharmacy Benefit Managers preferred.
• Demonstrated proficiency in Microsoft Excel, including developing PivotTables, performing lookup functions (VLOOKUP, XLOOKUP, INDEX/MATCH), and utilizing formulas to support data analysis and reporting preferred.

Responsibilities

• Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
• Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates.
• Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert.
• Conduct complex investigations, document findings, and ensure corrective actions are made.
• Interface with external clients, regulators, vendors, suppliers, internal stakeholders, and high level management.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level