Manager Government Program Compliance, Pharmacy

Health Care Service Corporation•Nashville, TN

20h•Remote

About The Position

HCSC is looking for a dynamic individual to join its Corporate Compliance team! This position is responsible for evaluating Government Program (Medicare and Medicaid) regulations, guidance and contracts, assessing the risk that those items present with respect to HCSC government contracts; may manage direct reports and provide oversight of the business’ operational compliance with the requirements through multiple mechanisms such as review of reports, attendance at operational meetings, and targeted monitoring of areas of concern. This role ensures our organization adheres to federal/state/local laws, regulations, and contractual obligations and will develop policies, conduct monitoring, manage risk, and act as a liaison with regulatory agencies to prevent legal penalties. Will be working independently to identify risks and issues of noncompliance, develop strategies to mitigate and remediate those risks and issues and work with Corporate Compliance and business personnel, as well as all levels of HCSC management and governmental agencies in order to implement controls and processes and report on results. NOTE: this role is TELECOMMUTE; sponsorship will NOT be extended either now or in the future.

Requirements

Bachelor’s Degree and five (5) years’ experience in healthcare compliance OR nine (9) years’ experience in health plan, regulatory compliance or risk management.
One year of leadership/supervisory experience.
Experience communicating and building relationships with internal business units and/or various external governmental agencies.
Strong critical thinking, risk assessment and mitigation.
Ability to influence processes to achieve results.
Excellent verbal and written communication skills.
Ability to work independently and be a self-starter.
Organizational, project management, analytical and decision-making skills.
PC proficiency to include MS Teams, Word, PowerPoint and Excel as well as Workday.

Nice To Haves

Government Programs Healthcare Compliance experience - equivalent experience will be considered.
Knowledge of Medicare Advantage-Part D or other regulatory experience.
Master’s Degree.
Government programs operational experience.

Responsibilities

Identify, review, analyze and understand contractual and regulatory requirements.
Evaluate Government regulations, guidance and contracts, and identify specific risks that they present to HCSC government contracts.
Responsible for performance of HCSC Office of Foreign Assets Control and Debarment process and management of staff performing the process. (Validation that individuals and entities with which HCSC does business are not precluded from participating in state or federally funded programs.)
Review Government Programs policies and procedures, workflows, training materials and other documentation for compliance with requirements.
Consult with the business and provide guidance as the business plans, implements and monitors its compliance with contractual and regulatory requirements.
Identify and follow up on compliance issues and track issues to resolution.
Provide accurate and complete documentation of reported information, risks, issues, status and results.
Work with the business to agree upon issues, root causes, remediation steps, deliverables, additional training and education, communications, internal controls, compliance reviews or modifications to processes and due dates.
Manage or oversee management of issue resolution process which may include, as appropriate, but is not limited to identifying barriers to meeting due dates identifying actions or escalations needed to address barriers escalating failure to meet due dates escalating barriers appropriately recommending disciplinary actions or other appropriate means to hold business owners accountable for actions or lack of actions.
Validate that business remediation activities successfully addressed agreed-upon root causes, deliverables and remediation steps.
Manage or provide oversight of remediation including: identification of root cause(s), identification and stratification of risks, development and implementation of recommendations for processes that would result in their mitigation.
Oversee development of remediation plan with the business including setting agreed-upon actions, deliverables and due dates and track execution of the remediation plan.
Provide compliance consultation and guidance to business owners, which may include participating in regular meetings, working with management to identify and mitigate risks and coordinating responses to questions from regulators.
Communicate and lead by influence with internal and external stakeholders at all levels throughout HCSC to achieve effective outcomes.
Identify, design, and perform targeted monitoring and/or reviews to determine if HCSC is in compliance with the terms of specific government contracts, regulations, guidance and private contracts.
Document results and communicate findings to the business.
Provide and manage input related to the Risk Assessment process in order to most effectively stratify the risks presented by government business.
Coordinate, facilitate and take notes at internal and external meetings, including meetings with regulators.
Prepare and distribute materials to participants.
Manage activities of direct reports.
Review operational reports from the business, track and trend results and identify issues or risks of noncompliance.
Create summary reports for management on issues and risks of non-compliance.
Report on Compliance Program activities, effectiveness and status, including ad hoc and routine management reports.
Contribute to preparation of quarterly compliance reports to HCSC boards and committees.