This position will be the key leader in developing and managing Magellan Rx Medi-Cal Problem Correction Process (PCP) through SAI Global Compliance 360. The individual will be responsible in ensuring problem statements entered meet validation, ensuring Corrective Action Plans (CAPs) are implemented and validated.
Assists 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 regulations.
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 areas.
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.
Other Job Requirements
Responsibilities
Requires 5+ years of compliance related experience.Strong interpersonal, organizational, and project management skills.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.
General Job Information
Title
Compliance Manager
Grade
26
Work Experience - Required
Compliance, Medicare, PBM (Pharmacy Benefit Management)
Work Experience - Preferred
Education - Required
Bachelors
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live. Our strong culture of caring is the common thread in both our business strategy and our work environment. We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity. Magellan is a place where you can thrive.
Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.
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