Job Information

Prime Therapeutics Compliance Manager MRx (Remote) in Denver, Colorado

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 MRx (Remote)

Job Description Summary

Assists with the implementation and management of the Magellan Rx Compliance Program, and Program Integrity Plan. Responsible for the oversight of regulatory and contract compliance activities for the Pharmacy Benefit Manager (PBM) and all functional areas and markets managed by Magellan Rx Management, including regulations issued by the Centers for Medicare and Medicaid Services (CMS), and other state and federal regulations.

Job Description

  • Conducts monitoring, auditing and oversight functions for the Pharmacy Benefit Manager (PBM).

  • Dual accountability and responsibility for monitoring, auditing and oversight functions for all Magellan Rx managed product lines (Medicare, Medicaid, Commercial Exchange) and functional areas.

  • Assists with the development of the annual Risk Assessment for MRx and Delegated Entities.

  • Leads Client Audit Support for all PBM and MRx clients.

  • Provides support for MRx regulatory audits.

  • Manages Delegation Oversight activities, including monitoring, auditing and corrective actions of First Tier, Downstream and Related Entities (FDRs) and delegated entities for the PBM and all Magellan Rx product lines.

  • Coordinates activities with Special Investigations Unit (SIU) regarding fraud, waste and abuse.

  • Attends client meetings to discuss compliance matters.

  • Partners with operational areas to provide guidance, information, monitoring/auditing requests and results and corrective action oversight and approval.

Responsibilities

  • Experience working for a PBM, Managed Care Company, or other related organization strongly preferred.

  • Requires 5+ years of compliance related experience.

  • Strong interpersonal, organizational, and project management skills.

  • Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.

  • Excellent verbal and written communication skills.

  • Knowledge of Medicare regulations.

  • Experience and thorough understanding of Microsoft Office, flow charting and other relevant software systems and applications.

Work Experience

Work Experience - Required:

Compliance, Medicare, PBM (Pharmacy Benefit Management)

Work Experience - Preferred:

Education

Education - Required:

Bachelors

Education - Preferred:

Certifications

Certifications - Required:

Certifications - Preferred:

Potential pay for this position ranges from $72,130.00 - $115,410.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ​ If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email Careers@primetherapeutics.com.