Mgr Compliance

Role Overview: 

At the direction and assistance of the Compliance Director, the Compliance Manager is responsible for supporting and enhancing the organization’s compliance program through oversight, monitoring, reporting, and partnership with key stakeholders across lines of business. This role oversees the organization’s compliance for Pharmacy and PBM oversight. The role will work closely with all plan market, pharmacy and compliance leadership teams to maintain an effective compliance program with measurable outcomes based on data. The Compliance Manager performs review and synthesis of operational metrics and delivers actionable insights on compliance trends, emerging risks, and control performance. In addition, the role will focus heavily on all elements of an effective compliance program within the pharmacy and PBM delegation oversight.

Work Arrangement:

• Remote within the United States, working Eastern Standard Time.
• For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Responsibilities:

• Oversee the development and improvement of Pharmacy and PBM Delegation oversight and compliance.
• Support and/or manage compliance investigations through resolution, including issue triage, fact gathering, documentation, and communication of outcomes.
• Develop, maintain, and enhance compliance dashboards and reporting, ensuring accurate, timely, and actionable insights for stakeholders.
• Analyze and synthesize operational and compliance metrics; translate findings into clear reporting for leadership and business partners.
• Partner with key stakeholders across lines of business to implement compliance requirements, remediate issues through corrective action, and strengthen controls.
• Prepare and maintain compliance documentation, including procedures, workflows, evidence of monitoring, and reporting artifacts.
• Contribute to compliance program governance, including periodic reporting, committee/leadership updates, and support for compliance risk assessment.
   

Education/Experience:

• Bachelor’s Degree in Business, Social Science, or relevant field required. Legal background helpful. Additional experience and background are considered in lieu of a degree. 
• 3+ years in a managed healthcare government products (preferably pharmacy or PBM) environment required.
• Experience in the areas of compliance and delegation oversight preferred.
• A minimum of 1 year of supervisory experience is required.
• Knowledge of compliance concepts and practices (prevention, detection, and correction) is preferred
• Experience creating reporting and monitoring dashboards for transparency to daily operations through Executive Leadership.
• Experience being a plan representative in regulatory audits and maintaining audit readiness. 
• Ability to create and maintain compliance programs as needed to support multiple lines of business.
• Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.
• Self-motivated with demonstrated project management skills.
• Certified in Healthcare Compliance preferred.
   

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.