Job DescriptionThis position assists with the implementation of the Magellan Pharmacy Compliance Program.
- Assists with the implementation of the Magellan Rx Compliance Program, and educates the management team and staff about compliance and the appropriate components of the compliance program and the Office of Inspector General (OIG) Work Plan.
- Administers and customizes the tool utilized for the management of compliance issues.
- Tracks and manages compliance issues.
- Manages corrective action plans.
- Manages issues submitted to Compliance Mailbox and escalates to the Medicare Compliance Officer.
- Reviews CMS HPMS memos, and regulatory guidance and disperse to impacted operational areas and monitor to completion.
- Responsible for organizational compliance with HPMS notices, CMS and regulatory guidance, as appropriate.
- Interacts effectively with internal operations areas to provide guidance and information.
- Reviews operational policies and procedures to ensure compliance with CMS regulations and state and federal laws.
General Job Information
TitleManager, Pharmacy and Medicare Compliance - remote opportunity
Job FamilyLegal Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date9/25/2019
Date Requisition Created9/24/2019
Work ExperienceMedicare Part D (MedD), PBM (Pharmacy Benefit Management)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 3+ years of experience in compliance-related matters in the health care industry.
- Experience working for a Managed Care Company or other health related organization.
- Knowledge of group health, managed care claims and/or pharmacy claims payment processes.
- 5+ years in Medicare Part D, Medicare Advantage, and/or managed Medicaid.
- Solid understanding of CMS (Centers for Medicare and Medicaid).
- Solid understanding of HPMS System and STAR ratings.
- Ability to collaborate with many functional areas of a large national organization. Knowledge of HIPAA.
- Proficient with MS-Office Word, Excel, PowerPoint, etc.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
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