9 days old

Pharmacy Compliance Senior Manager- Work at home

Cigna
Bloomfield, CT 06002
  • Job Code
    22027174
ROLE SUMMARY
  • Reporting to the Pharmacy Compliance Director, this position will be responsible for leading Provider and Supplier compliance to Medicaid and Medicare requirements, and other Pharmacy Compliance programs managing an effective program of healthcare compliance. This role will be an integral part of the Pharmacy Compliance team supporting all ESI Pharmacies, including their U.S. subsidiaries, and affiliated products under Evernorth Health Services. The ideal candidate will have a strategic mindset and have the ability to drive change and influence others, as well have broad based knowledge of pharmacy operations and government payor programs, and be able to identify compliance impacts and risks.

ROLE RESPONSIBILITIES

Key Duties :

  • Manage a team of compliance professionals accountable for government payor compliance of the ESI pharmacies.
  • Compliance with government payor requirements for ESI Pharmacy Providers and Suppliers.
  • Manages a change control process for the intake, communication, business compliance analysis, and repository of government payor requirements (e.g., State Medicaid and CMS requirements).
  • Understanding the impact of other government payor Provider and Supplier requirements (e.g., State Medicaid and CMS requirements) as it pertains to limitation on pharmacy and medical plan benefit coverage and services.
  • Research and respond to pharmacy and government payer compliance questions in consultation with Legal and Compliance stakeholders.

Compliance Program Duties :

  • Coordination and development of auditing and monitoring plans focusing on areas of high compliance risk within the pharmacy government payor space.
  • Creation of dashboards and status updates which communicate audit and monitoring results, trends, and summarize risk remediation activity.
  • Develops high quality and effective presentations and reports for senior management, including Board / Committee reports, covering the compliance landscape.
  • Assist peers in managing and prioritizing workload assignments across multiple priorities to achieve optimal compliance departmental performance.
  • Manages and maintains team's Compliance Work plan.
  • Participate in assessment of risk for ESI Pharmacies.
  • Lead, participate and facilitate accessible knowledge and guidance for business stakeholders including Compliance committees and other delivery mechanisms as needed.
  • Update, revise, and maintain applicable departmental policies and procedures, and support the review of policies and documents for supported business units.
  • Training development and support of business stakeholders on applicable compliance topics.

Leadership Duties :

  • Strong team leadership of core responsibilities while developing a diverse, nimble, and knowledge team.
  • Takes ownership and accountability in own work responsibilities.
  • Demonstrates dedication, passion, and ethics towards department duty.
  • Development and management of technology and automation used to support Pharmacy Compliance program activities (Service Now, SharePoint, etc.).
  • Develops and maintains a strong working knowledge of Evernorth's companies, products, licenses and business segments.

Soft skills :

  • Excellent oral, written presentation and communication skills
  • Ability to lead and influence in a matrixed environment is critical
  • Proven track record of delivering results of high quality and sustainability
  • Strong problem solving and root cause identification skills
  • Strong business acumen, with proven ability to leverage knowledge base to quickly come up to speed in new business areas and new types of projects
  • Proven ability to develop strong working relationships and establish a high level of credibility across functional and lines of business and organizational levels
  • Adapts to ambiguous or unfamiliar terrains; Strong strategic thinker
  • Ability to lead teams through growth, change, and development

POSITION REQUIREMENTS / QUALIFICATIONS

  • Bachelor's degree or equivalent training and mastery required; Registered Pharmacist is required for this role.
  • Minimum of 6 -8 years' experience in pharmacy practice focused in specialty, home infusion and mail order pharmacy services needed.
  • Minimum of 6-8 years' experience in a compliance or regulatory role, with a focus on direct health care experience involving knowledge of government payor and regulatory requirements for pharmacy providers and suppliers, strongly preferred but not required.
  • *Government payor experience, in particular Medicaid required
  • Successful management experience in highly matrixed environment with proven results.
  • Excellent written and oral communication skills.
  • Strong planning/organizing/prioritizing skills with ability to meet changing priorities and critical deadlines.
  • Expertise in the use and application of the Microsoft suite of programs including Word, Excel, Outlook, and PowerPoint.
  • Exceptional integrity, critical thinking, and leadership stature.
  • Takes personal accountability for team and organizational results.
  • Prior experience leading a cross functional team.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 122,900 - 204,800 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna .

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

Cigna has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.





Posted: 2023-01-21 Expires: 2023-02-19
Sponsored by:
ADP Logo
Sponsored by:
Bank of America Logo

Featured Jobs[ View All ]

Featured Employers

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Pharmacy Compliance Senior Manager- Work at home

Cigna
Bloomfield, CT 06002

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast