Mgr Operational Compliance

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- Job Posting Title

Mgr Operational Compliance
- Job Description
- The Manager Operational Compliance is responsible for driving the work effort, volume, analysis, implementation and productivity of all regulatory, audit (internal and external), and quality efforts to ensure the department is operating in compliance with regulatory and/or contractual obligations. This position ensures the appropriate monitoring, impact assessment, implementation and planning occurs for all incoming and changing regulatory requirements and leads the tracking, documentation, measurement, adherence, corrective action and maintenance plans on behalf of the department.
- Responsibilities
- Oversee the operational interpretation and compliance with client delegation agreements, accreditation entities, and state or federal contractual obligations in all departmental activities, and may lead or oversee the development and maintenance of standard operating procedures (SOPS), Desktop procedures (DTPS)/User Guides, policies and process flows
- Serve as point of escalation for internal and external business partners regarding regulatory, audit, and quality efforts for the designated business unit
- Lead a team conducting regulatory intake, internal and external audit support, quality monitoring, and measurement, reporting, and delivery of results to the appropriate audiences
- Manage the coordination and delivery of necessary artifacts for internal, client, or regulatory audits, inquiries and/or accreditation activities
- Drive ongoing audit readiness for the department by identifying trends and ensuring the corresponding processes, training, communications, and documents are updated and disseminated; review audit feedback, initiate action items related to audit or compliance review findings, develop and monitor corrective action plans, and in partnership with operational compliance leadership, prepare executive reporting that summarizes operational compliance strategies, activity and results
- Manage department staffing, performance and development and consistently demonstrate Prime’s leadership expectations during interactions with direct reports, cross functional and external stakeholders
- Other duties as assigned
- Minimum Qualifications
- Bachelor’s degree in business, legal studies, finance, health services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
- 6 years of work experience in compliance, quality, audit, regulatory, process improvement and/or operations experience in healthcare or Pharmacy Benefit Management (PBM)
- 1 year of leadership/people management experience
- Must be eligible to work in the United States without need for work visa or residency sponsorship
- Additional Qualifications
- Demonstrated knowledge of audit response protocols
- Ability to effectively distill complex information into clear and compelling presentations
- Strong interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization
- Critical thinking and analysis skills with the ability to translate regulations into operational requirements, solve complex problems, and/or identify process improvements
- Ability to effectively represent the business and interact with external entities
- Organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising quality
- Expert level of proficiency in Microsoft Office Suite (Word, Excel, Power Point, Visio and database)
- Preferred Qualifications
- Master of Business Administration (MBA) or other advanced degree
- Experience working within, the assigned department
- Project management experience
- Minimum Physical Job Requirements
- Ability to travel up to 20% of the time
- Constantly required to sit, use hands to handle or feel, talk and hear
- Frequently required to reach with hands and arms
- Occasionally required to stand, walk and stoop, kneel, and crouch
- Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
- Reporting Structure
- Reports to Director or Senior Director in the Operations Regulatory or Supply Chain departments

Potential pay for this position ranges from $91,100.00 - $145,300.00 based on location, experience and skills.

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- Benefits