Director of Compliance and Development bei QNS Recruiting

Director of Compliance and Development

RIDC Park - Pittsburgh, Pa 

Grane PBM’s Director of Compliance is responsible for ensuring that Grane PBM operates within all legal, regulatory, and contractual requirements. This role involves overseeing compliance programs, managing audits, and mitigating risks related to pharmacy benefits, for PACE, Medicare/Medicaid, and other healthcare regulations.

Key Responsibilities:

• Regulatory Compliance: Ensure adherence to federal and state laws, including CMS (Centers for Medicare & Medicaid Services) regulations, HIPAA, ERISA, and other applicable requirements.

• Audit Management: Oversee internal and external audits, including those conducted by government agencies and PBM clients.

• Policy Development: Develop, implement, and update compliance policies, procedures, and training programs.

• Risk Management: Identify compliance risks and develop mitigation strategies to prevent violations and penalties.

• Contract Compliance: Ensure that Grane PBM agreements with health plans, pharmacies, and pharmaceutical manufacturers align with legal and regulatory standards.

• Investigations & Reporting: Conduct internal investigations related to potential compliance violations and report findings to senior leadership and regulatory agencies when required.

• Liaison with Regulators: Serve as the primary contact for regulatory agencies, ensuring timely reporting and resolution of compliance issues.

• Duties as assigned.

Qualifications:

• 5+ years of experience in PBM, healthcare compliance, or regulatory affairs.

• Strong knowledge of CMS regulations, PACE, Medicare Part D, Medicaid, and pharmacy benefit operations.

• Experience managing audits and working with legal and regulatory bodies.

• Excellent communication and leadership skills.

• Ability to analyze complex regulations and translate them into actionable policies.

 eoe

fm0418