Compliance Manager, MRx - Remote in California
Company: Prime Therapeutics
Location: Des Moines
Posted on: January 27, 2023
Our work matters. We help people get the medicine they need to
feel better and live well. We do not lose sight of that. It fuels
our passion and drives every decision we make.Job Posting
TitleCompliance Manager, MRx - Remote in CaliforniaJob Description
SummaryAssists with the implementation and management of the
Magellan Rx Compliance Program, and Program Integrity Plan.
Responsible for the oversight of regulatory and contract compliance
activities for the Pharmacy Benefit Manager (PBM) and all
functional areas and markets managed by Magellan Rx Management,
including regulations issued by the Centers for Medicare and
Medicaid Services (CMS), and other state and federal
- Remote - Candidate must live in California
- Conducts monitoring, auditing and oversight functions for the
Pharmacy Benefit Manager (PBM).
- Dual accountability and responsibility for monitoring, auditing
and oversight functions for all Magellan Rx managed product lines
(Medicare, Medicaid, Commercial Exchange) and functional
- Assists with the development of the annual Risk Assessment for
MRx and Delegated Entities.
- Leads Client Audit Support for all PBM and MRx clients.
- Provides support for MRx regulatory audits.
- Manages Delegation Oversight activities, including monitoring,
auditing and corrective actions of First Tier, Downstream and
Related Entities (FDRs) and delegated entities for the PBM and all
Magellan Rx product lines.
- Coordinates activities with Special Investigations Unit (SIU)
regarding fraud, waste and abuse.
- Attends client meetings to discuss compliance matters.
- Partners with operational areas to provide guidance,
information, monitoring/auditing requests and results and
corrective action oversight and approval.Responsibilities
- Requires 5+ years of compliance related experience.
- Strong interpersonal, organizational, and project management
- Ability to research, obtain, coordinate, and integrate feedback
and directions from diverse operational groups and organizations
into a written product.
- Excellent verbal and written communication skills.
- Knowledge of Medicare regulations.
- Experience and thorough understanding of Microsoft Office, flow
charting and other relevant software systems and applications.
- Experience working for a PBM, Managed Care Company, or other
related organization strongly preferred.Work ExperienceWork
Experience - Required:Compliance, Medicare, PBM (Pharmacy Benefit
Management)Work Experience - Preferred:EducationEducation -
Preferred:CertificationsCertifications - Required:Certifications -
Preferred:Potential pay for this position ranges from $72,130.00 -
$115,410.00 based on experience and skills. Pay range may vary by
8% depending on applicant location.To review our Benefits,
Incentives and Additional Compensation, visit our Benefits Page
(https://www.primetherapeutics.com/careers/benefits/) and click on
the "Benefits at a glance" button for more detail.Prime
Therapeutics LLC is an Equal Opportunity Employer. We encourage
diverse candidates to apply and all qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex (including pregnancy), sexual orientation, gender
identity or expression, genetic information, marital status, family
status, national origin, age, disability, veteran status, or any
other legally protected class under federal, state, or local
law.Prime Therapeutics' fast-paced and dynamic work environment is
ideal for proactively addressing the constant changes in today's
health care industry. Our employees are involved, empowered, and
rewarded for their achievements. We value new ideas and work
collaboratively to provide the highest quality of care and service
to our members.If you are looking to advance your career within a
growing, team-oriented, award-winning company, apply to Prime
Therapeutics today and start making a difference in people's
lives.Prime Therapeutics LLC is an Equal Opportunity Employer. We
encourage diverse candidates to apply and all qualified applicants
will receive consideration for employment without regard to race,
color, religion, sex, sexual orientation, gender identity, national
origin, disability, or veteran status. If you are an applicant with
a disability and need a reasonable accommodation for any part of
the employment process, please contact Human Resources at
1.866.469.1257 or email Careers@primetherapeutics.com.
Keywords: Prime Therapeutics, Des Moines , Compliance Manager, MRx - Remote in California, Executive , Des Moines, Iowa
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