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Regulatory Compliance Manager

Company: Southern Scripts
Location: Mount Pleasant
Posted on: June 6, 2024

Job Description:

Job DescriptionRegulatory Compliance ManagerRole and ResponsibilitiesThe Regulatory Compliance Manager is responsible for ensuring Liviniti and its affiliated companies maintain compliance with all relevant laws, regulations, and guidelines related to its pharmacy benefit management operations, including but not limited to, state and federal regulatory requirements and HIPAA, HITECH, ERISA, and CMS. The Regulatory Compliance Manager will serve as an integral member of the Legal and Compliance team. The Regulatory Compliance Manager is required to perform the following duties and professionally undertake the following responsibilities:

  • Develop, implement, and maintain an effective compliance program for pharmacy benefit management activities.
  • Monitor and assess compliance with laws, regulations, and guidelines related to PBM and affiliated entities.
  • Conduct regular audits and assessments to identify and mitigate compliance risks.
  • Provide guidance and training to employees on compliance matters related to PBM.
  • Investigate compliance issues and implement corrective actions as necessary.
  • Monitor and report on compliance metrics and key performance indicators to senior management.
  • Serve as a point of contact for regulatory agencies and external auditors during compliance reviews and audits.
  • Keep abreast of changes in laws, regulations, and guidelines related to PBM and communicate changes to relevant stakeholders.
  • Collaborate with internal and external stakeholders, including regulatory agencies, to ensure compliance with PBM requirements.
  • Draft compliance notices to distribute to internal and external stakeholders.
  • Prepare and submit reports on compliance activities to management and regulatory agencies as required which includes but is not limited to CMS reporting and OCR (HIPAA reporting).
  • Develop and maintain an incident management process for all reported compliance matters.
  • Foster a culture of compliance and ethical behavior throughout the organization.
  • Abide by all obligations under HIPAA related to Protected Health Information (PHI).
  • If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.
  • Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.
  • Flexibility to understand, appreciate, and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.Required Skills and Competencies
    • Ability to review and interpret state and federal guidelines.
    • Strong analytical and problem-solving skills.
    • Excellent communication and interpersonal skills.
    • Ability to work independently and collaboratively in a team environment.Supervisory ResponsibilityThere could be supervisory responsibility for this role.Position Type and Expected Hours of Work
      • Full-time, salary/exempt position.
      • Some flexibility in hours is allowed, but the employee must be available during the "core" work hours of 8:00 AM to 5:00 PM CT. We cover clients from the West to East Coast, work times must be adjusted to cover meetings in all time zones. Ability to work extended hours, weekends, and holidays pursuant to industry demands.TravelSome travel may be needed 5% - 10% of the time depending on the legal needs of the company.Required Education and Experience
        • Bachelor's degree in healthcare administration, business administration, or related field required. Master's degree preferred.
        • Certified in Healthcare Compliance (CHC)
        • Minimum of 5 years of experience in healthcare compliance, with a focus on pharmacy benefit management.
        • In-depth knowledge of laws, regulations, and guidelines related to pharmacy benefit management, including HIPAA, HITECH, ERISA, and state PBM requirements.Liviniti, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Liviniti, LLC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.Liviniti, LLC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti, LLC employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/D/V


Keywords: Southern Scripts, Mount Pleasant , Regulatory Compliance Manager, Executive , Mount Pleasant, South Carolina

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