Manager, Licensing and Regulatory Compliance

Independent Health • Buffalo, NY

8d • $90,000 - $110,000

About The Position

The Manager, Licensing and Regulatory Compliance, will be responsible for overseeing the daily operational activities of program strategies to support Pharmacy Benefit Dimension’s accreditations, certifications, licenses, and regulatory requirements (e.g., URAC PBM accreditation, Utilization Review licenses). They will oversee reporting requests and the submissions necessary to support them. They will also have oversight of the licensing vendor. The Manager will also oversee the policy and procedure process, and activities supporting PBD’s Quality Management Committee and Medicare Part D STAR measures. In addition, the position will oversee the management of non-compliance events including but not limited to corrective action plans and privacy and security events. Occasional weekends and holidays are a requirement of the position.

Requirements

• Bachelor’s degree required. An additional four (4) years of experience will be considered in lieu of degree.
• Five (5) years of corporate/regulatory licensing, quality monitoring/reporting, or program/process management experience required.
• Two (2) years of progressive leadership/management experience required.
• Excellent organizational, time management, analytical and critical thinking skills, with ability to analyze abstract components of legislation, regulations, or accreditation standards for requirements identification.
• Experience in the creation or review of policies, procedures, and reports.
• Ability to assess controls needed to meet requirements, render decisions and troubleshoot issues.
• Advanced PC and Microsoft Office applications skills required.
• Excellent interpersonal, written and verbal communication skills.
• Proven examples of displaying PBDs values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Nice To Haves

• Experience working with regulatory and accreditation agencies including but not limited to URAC, DOL and CMS and compliance, quality monitoring/reporting or program management preferred.
• Experience with self-funded group health plans preferred.

Responsibilities

• Manage the licensing vendor relationship to ensure all reporting, information and supporting documentation is transmitted and necessary applications are filed and tracked ensuring all licenses are acquired and/or maintained.
• Oversee the review of standards, regulations and legislation along with the development and implementation of processes and documentation for accreditation, certification, registration and/or licensing.
• Oversee project teams and performance of preparation activities for accreditation, certification, registration and/or licensing submissions, mid-cycle audits and renewals; including but not limited to coordinating and/or assisting in gathering requested information, updating, and reviewing documentation for accuracy and other activities as deemed necessary.
• Manage and lead periodic reviews and mock audits as necessary to ensure PBD is audit ready for accreditation renewals.
• Manage the oversight of the Medicare Part D STAR measures dashboard, identify and communicate trends to ensure leadership is able to take appropriate operational action.
• Manage the policy and procedure process, policy committee meetings and general daily activities to ensure adherence and provide prompt reporting of instances of actual or potential non-compliance.
• Oversee reporting and remediation efforts for instances of non-compliance, including but not limited to corrective action plans and HIPAA privacy and security events.

What This Job Offers

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