Senior Partner, PBM Compliance

Job Description:

The Senior Compliance Partner provides strategic compliance guidance to Select Health leaders, with a primary focus on the standalone services offered through Scripius, the organization’s pharmacy benefit management (PBM) company.

This position is accountable for highly complex, high-risk portfolios using professional judgement. The Senior Compliance Partner is responsible to develop training and educate senior leaders, physicians, clinicians, physicians and caregivers on compliance and ethics risks.

Location

• This position is primarily remote with occasional need for business travel. Candidates within Mountain time zone will be considered and candidates local, or willing to relocate to Utah, are preferred.
• Currently, we are not hiring remote workers in the following states: CA, CT, HI, IL, NY,  RI, VT, and WA. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings.

Essential Functions

• Files and maintains PBM/TPA licenses in each state with presense, track existing and new rules and regulations in those states, and support Scripius with its existing client relationships.
• Leads complex investigations and projects within assigned portfolio, including those with attorney-client privilege
• Establishes and maintains effective relationships and communication channels with internal and external stakeholders. Promotes effective mechanisms to encourage a culture of compliance and reporting.
• Leads or participates in cross functional teams to address regulatory risk and implement regulatory requirements through projects and assignments.
• Evaluates and identifies risks, and develops and leads corrective action plans across an assigned portfolio of products, service lines or geographies.
• Proposes plans to adjust organizational risk response. Leads implementation of changes, with oversight and direction.
• Develops and implements corrective action plans and remediation measures to address any compliance issues or deficiencies identified by internal or external audits, investigations, or regulatory agencies.
• Monitors and analyzes changes in the regulatory environment and enforcement landscape, and assesses the impact and implications for the organization.  Implements monitoring and auditing activities based on industry best practices.
• Provides guidance and support to leaders and business units on regulatory compliance issues and requirements, and proposes recommendations and solutions to ensure compliance.
• Develops and delivers compliance education and training programs to relevant stakeholders, such as employees, providers and business partners.
• Investigates and responds to compliance complaints, allegations, or incidents, and coordinates with legal counsel, human resources, and other departments as appropriate.
• Identifies and implements best practices and continuous improvement initiatives to enhance the regulatory compliance performance and culture of the organization.
• Promotes a culture of compliance and ethics and reduces Intermountain's risk of Government audits, fines, penalties and sanctions through close coordination with Compliance Department leadership.

Skills

• Compliance Programs 
• Leadership
• Relationship Building
• Communication
• Risk Compliance 
• Confidentiality 
• Facilitator
• Problem Solving
• Collaboration
• Critical Thinking

Minimum Qualifications

• Bachelor’s Degree in healthcare administration or similar field preferred.  (Degree must be obtained through an accredited institution.  Education is verified.)
• Demonstrated professional-level experience in a regulatory, compliance or risk management role in the healthcare sector.
• Demonstrates expert level knowledge and understanding of federal and state laws and regulations related to health care billing, coding, reimbursement, contracting, and risk adjustment, such as Medicare, Medicaid, HIPAA, False Claims Act, Anti-Kickback Statute, Stark Law, and MACRA.
• Ability to interpret and apply complex healthcare regulations in a healthcare system and to assess and evaluate gaps with demonstrated knowledge of the healthcare industry.
• Demonstrates strong communication, presentation and interpersonal skills with the ability to influence and collaborate with diverse stakeholders. 
• Demonstrated discretion to maintain confidential information, evaluate alternatives, and make effective decisions.
• Demonstrated experience implementing the eight elements of an effective compliance program.
• Demonstrates high ethical standards, integrity, and professionalism, with a commitment to Intermountain Health's missio