External Compliance Support Manager I-II

Exemption Status:United States of America (Exempt)

$71,614 - $95,784 - $119,953

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Summary:  The External Compliance Support (ECS) Manager manages and oversees compliance auditing activities conducted by external entities such as MedImpact’s clients, consultant auditors (hired by MedImpact clients), or regulatory authorities.   This position manages requests received from clients undergoing audits to support those regulatory audits.  The Manager supports compliance audits of MedImpact by its clients and regulatory bodies such as CMS, state departments of insurance, and others.   

Essential Functions and Responsibilities include the following: (other duties may be assigned)

• Collaborates with identified subject matter experts to ensure compliance audit activities are conducted effectively and efficiently. Ensures notification, scope, and timelines of scheduled compliance audits are appropriately communicated to organization.

• Coordinates support activities with internal operational areas.  Oversees remediation, including corrective action plans, for all audits under ECS management.  Maintains corporate records of materials provided and received in compliance audit support activities. 

• Evaluates compliance audit requests to determine scope, applicability, and impact on organization.  Reviews any applicable regulatory requirements and contractual requirements.  Advises the appropriate internal audit support members of any applicable regulatory, contractual requirements or previous corrective action pertinent to the compliance audit activity.

• Develops and maintains standard compliance auditing information on various topics that can be utilized by external entities performing compliance audits on MedImpact. 

• Develops and maintains guidelines of standard materials to support specific compliance auditing as requested by external entities.  Maintains corporate records of materials provided to support compliance auditing activities, including the specifications utilized to create data reports.

• Oversees and manages a formalized follow-up session with appropriate internal audit support members, and leadership as appropriate, including follow-up on findings (e.g., corrective action plans).  Works with affected areas to ensure findings are addressed and within stated timelines.

• Prepares and presents compliance audit findings, corrective actions, and other relevant information to leadership.

• Assists the Corporate Compliance Officer with compliance program initiatives as well as educates and trains employees.

• Assists with the accreditation efforts (URAC and others) as needed to include information gathering.  Ensures standards are met; supports compliance assurance efforts related to MedImpact and subsidiary organizations.   

• Maintains accurate and timely records in tools used for tracking and reporting.

In addition to the above duties (level I) – the level II is responsible for: 

• Identifies process gaps and potential areas for improvement in standard compliance audit activities, collaborates with leadership to convey potential solutions, and provides appropriate documentation.  

• Identifies knowledge gaps and collaborates with leadership to ensure information sharing, education and training is available as applicable, including the development of such training.

• Coordinates and manages compliance support activities (projects, audit protocols, audit types) with internal operational areas as directed by leadership.

• Evaluates variant audit requests and escalates appropriately to leadership with a written audit summary, status, and plan of action.

• Evaluates and determines how to meet expectations of the auditing entity while assessing risk to MedImpact and impacting client satisfaction and expectations. 

• Presents information and responds to questions from groups of managers, clients, internal customers, including generating compliance audit trends and activity numbers.

Supervisory Responsibilities        

No supervisory responsibilities.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to: manage difficult or emotional client situations, respond promptly to client needs, solicit client feedback to improve service, respond to requests for service and assistance from clients, and meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience                                             

Bachelor’s degree in a related field (or equivalent combination of education and experience). Related experience required in the healthcare (or similar) industry conducting and/or participating in regulatory authority or third party audits.

Level I requirements - Normally requires at least 3+ years’ related experience.  Prior Pharmacy Benefit Management industry experience a plus. 

Level II requirements - Normally requires at least 5 – 8+ years’ related experience along with a good familiarity with Pharmacy Benefit Management.

Computer Skills

Level I requirements - Intermediate knowledge of MS Office (Word, Excel, Access, PowerPoint) and Outlook.  Familiarity with SalesForce (CRM tool).  Aptitude to learn new programs.

Level II requirements - Intermediate to advanced knowledge of MS Office (Word, Excel, Access, PowerPoint) and Outlook.  Ability to independently operate in C360.

Certificates, Licenses, Registrations

CHC, PMP, or CPhT (or any combination) preferred but not required.

Other Skills and Abilities    

Level I requirements:

• Basic knowledge of healthcare audit management.
• Excellent communications skills (verbal and written).

Level II requirements:

• Excellent working knowledge of audit management, MedImpact systems and operations.

Language Skills                                           

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Reasoning Ability                                                    

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills                                                 

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.  Ability to apply concepts of basic algebra and geometry.

Competencies                                              

To perform the job successfully, an individual should demonstrate the following competencies:

• Interpersonal Effectiveness - Demonstrates good people skills by showing a commitment to teamwork, resolving conflicts effectively and with respect for others’ viewpoints, respecting differences and building strong relationships and networks.

• Job-specific Expertise - Demonstrates solid command of relevant knowledge, skills, techniques, and technologies, keeps current with recent developments and best practices in the field, and establishes self as the go-to person for up-to-date knowledge in his or her area.

• Teamwork - Functions as a valuable team member by engaging in collaborative decision making and problem solving, constantly contributes positively as a team member, shares credit when appropriate and encourages teammates to use their knowledge and skills.

• Communication - Expresses self clearly and effectively in face-to-face interactions, presentations, and written documents, and employs active listening skills to ensure productive interactions.

In addition to Level I requirements Level II:

• Adaptability - Adjusts quickly to evolving situations by integrating new information, remaining flexible, recognizing, and implementing necessary changes and taking advantage of opportunities presented by new developments.

• Change Management - Exemplifies a positive, proactive response to change, fully grasps and articulates the envisioned results of the change process, keeps others informed about events and trends that may impact the organization, and involves others in the change process to maximize buy-in and minimize stress. 

• Professional Knowledge - Is knowledgeable about the business, possesses relevant job-specific and technological expertise, clearly understands the organizational structure, handles office politics well, and displays financial acumen.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is occasionally exposed to risk of electrical shock. The noise level in the work environment is usually moderate.

Work Location

This position must work on-site at the San Diego Headquarters (or other company location) for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders.  Periodic scheduled remote work may be permitted as allowed under the department’s policy and with management approval. 

Working Hours

This is an exempt level position requiring one to work the hours needed to get the job done.  Therefore, one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required.  This may be changed from time to time to meet the needs of the business.  Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel This position may require occasional domestic travel and attendance at seminars, conferences or other company locations.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.