Description

PBM Compliance Manager

Location: Must be within a 50 mile radius of a Pulse Point location.

This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days in office per week.

The PBM Compliance Manager is responsible for coordinating pharmacy compliance activities and initiatives across the PBM and the enterprise by maintaining department approved regulatory and legislative compliance plan and implementing effective internal controls.is responsible for managing foundational and strategic compliance responsibilities with consistent excellence that support the team and management.

How You Will Make an Impact

Primary duties for this managing level position, with moderate to advanced complexity and broad/enterprise scale may include, but are not limited to:

* Identifies, monitors, revises and tracks business unit processes and implementing procedures to ensure compliance with all related measures.

* Identifies potential risks associated with PBM activities and ensures procedures are in place to minimize risks.

* Partners with business units to ensure compliance with all statutory and regulatory requirements.

* Participates as compliance subject matter expert on all mandated projects; achieves business operational compliance with all related measures relative to HIPAA and SOX and Privacy and Security Office initiatives.

* Conducts, directs, leads and facilitates all activities related to Internal and External (Regulatory and Client) audits and responds to findings.

* Performs high level regulatory research, develops strategic plans and pro-actively anticipates business needs and requirements.

* Develops and implements training and communication plans; manages and leads scheduled and ad-hoc compliance projects; provides and delivers compliance consultation services to the business unit.

* Travels to worksite and other locations as necessary.

Minimum 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.

* MS/MBA or field related professional designation preferred.

Preferred Skills, Capabilities, and Experiences:

* MS/MBA/JD or professional designation preferred.

* Regulatory Experience reviewing Commercial Health Plan and Pharmacy related regulations strongly preferred.

* Pharmacy Benefit Manager (PBM) Compliance and audit Experience strongly preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $93K to $115K.

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.