Compliance Manager

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Compliance Manager - Medicaid - Remote
**Job Description**:
The Compliance Manager works closely with designated business areas, Legal, and other internal partners to identify changing laws and regulations, accreditation standards, and client contractual compliance obligations, interpret the impact, and manage solutions for designated business areas. This position serves as a consultant to internal stakeholders regarding the development, implementation and monitoring of compliance initiatives and helps to create a culture of compliance throughout the organization.

**Responsibilities**:

- Executes compliance procedures and enforces policy governance across the organization and assigned function to validate regulatory reporting requirements are met and that business operations are aligned with applicable regulatory guidance; designs, develops, implements, conducts and maintains effective compliance, risk, assessment, vendor and ethics awareness processes, audits, work plans and communications based on business need and risk ranking methodology
- Support designated Prime business teams in regulatory research, interpretation, and compliance with State and Federal regulations, including regulatory change management efforts needed within the business.
- Supports the prompt and thorough investigation of reported compliance-related issues, partnering with Legal and HR as appropriate
- Represents the compliance organization and at times, Prime, as a primary contact on contracts or significant enterprise projects; collaborates with and represents the interests of key internal and external stakeholders
- Serves as a consultant to management on major matters pertaining to policies, plans and objectives and provides Subject Matter Expertise in their areas of focus (Affordable Care Act, Medicare, Medicaid, Corporate Compliance, Compliance Assessment or Services etc.)
- Support designated Clients’ compliance and regulatory issues in coordination with the appropriate client engagement staff and internal business teams.
- Assist in the development, monitoring and risk identification related to guidance and operational compliance needs.
- Develop and track useful metrics to assist leadership in preparing periodic reports demonstrating effectiveness of function
- Manage the preparation, implementation and maintenance of compliance standards and procedures (Standard Operating Procedures, Desk Top Procedures, etc.) and review applicable operations teams’ documentation; develop regulatory monitoring and response strategies for regulatory changes or new laws/regulations to assist designated business area with regulatory change management efforts
- Provide direct, or indirect leadership to other compliance professionals, consistently role modeling Prime’s employee and leadership expectations
- May oversee and support audit action plans and/or corrective action plans for the designated business area; design remedies and support the business in implementing, tracking and completing their plans as required
- May evaluate overall compliance training requirements and develop and implement response plans and training solutions to support a culture of compliance across the enterprise; if supporting corporate compliance efforts, may manage annual conflict of interest and code of conduct programs
- Other duties as assigned

Minimum Qualifications
- Bachelor’s degree in business, healthcare, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
- 6 years of progressive work experience in legal or compliance related roles for a healthcare or Pharmacy Benefit Management organization, or within a highly regulated industry, including experience with Medicare, Medicaid, and the Affordable Care Act (ACA)
- Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications
- Exceptional written and oral communication skills
Experience assessing training requirements and developing, delivering and assessing effective enterprise training programs through a variety of channels
- Expert level understanding of effective compliance program principles, concepts, practices and standards; full breadth of knowledge around industry best practices and challenges and experience developing new concepts, techniques, standards and programs to support an organization’s compliance priorities
- Ability to effectively interpret and present complex information to a wide variety of audiences
- Ability to establish rapport and effectively influence at all levels within an organization
- Enhanced organizational skills with the ability to effectively work on multiple projects simultaneouslyPreferred Qualifications
- Certified Compliance a