Hybrid Manager, Licensing and Regulatory Compliance

at Independent Health

• Job title: Manager, Licensing and Regulatory Compliance
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $90,000 - $110,000 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Buffalo, United States

About the role

• Manager overseeing licensing and regulatory compliance for Pharmacy Benefit Dimensions. Responsible for operational activities and ensuring adherence to quality management and accreditation standards.

Responsibilities

• Overseeing the daily operational activities of program strategies to support Pharmacy Benefit Dimension’s accreditations, certifications, licenses, and regulatory requirements
• Oversee reporting requests and the submissions necessary to support them
• Oversee the licensing vendor
• Oversee the policy and procedure process, and activities supporting PBD’s Quality Management Committee and Medicare Part D STAR measures
• Manage the licensing vendor relationship to ensure all reporting, information and supporting documentation is transmitted and necessary applications are filed and tracked ensuring all licenses are acquired and/or maintained
• Oversee the review of standards, regulations and legislation along with the development and implementation of processes and documentation for accreditation, certification, registration and/or licensing
• Oversee project teams and performance of preparation activities for accreditation, certification, registration and/or licensing submissions, mid-cycle audits and renewals
• Manage and lead periodic reviews and mock audits as necessary to ensure PBD is audit ready for accreditation renewals
• Manage the oversight of the Medicare Part D STAR measures dashboard, identify and communicate trends to ensure leadership is able to take appropriate operational action
• Manage the policy and procedure process, policy committee meetings and general daily activities to ensure adherence and provide prompt reporting of instances of actual or potential non-compliance
• Oversee reporting and remediation efforts for instances of non-compliance, including but not limited to corrective action plans and HIPAA privacy and security events.

Requirements

• Bachelor’s degree required
• An additional four (4) years of experience will be considered in lieu of degree
• Five (5) years of corporate/regulatory licensing, quality monitoring/reporting, or program/process management experience required
• Two (2) years of progressive leadership/management experience required
• Experience working with regulatory and accreditation agencies including but not limited to URAC, DOL and CMS and compliance, quality monitoring/reporting or program management preferred
• Experience with self-funded group health plans preferred
• Excellent organizational, time management, analytical and critical thinking skills
• Experience in the creation or review of policies, procedures, and reports
• Ability to assess controls needed to meet requirements, render decisions and troubleshoot issues
• Advanced PC and Microsoft Office applications skills required
• Excellent interpersonal, written and verbal communication skills.

Benefits

• First-class perks and benefits
• Generous paid time off
• Full range of benefits