Director, PBM Compliance and Regulatory Affairs
ABOUT THE ROLE:
We are seeking an articulate, thorough and highly organized individual who is results driven with a passion for risk mitigation. The Director of PBM Compliance and Regulatory Affairs will be a critical leader of Rightway’s Compliance team. As a strategic member of the team, you will guide the integration of compliance obligations into the organization’s operational, contractual, data, technology, and client-facing processes. You will provide leadership and oversight to promote continuous regulatory readiness, strengthen risk management practices, establish and maintain effective compliance controls, validate compliance through evidence-based reviews, and foster a proactive culture of compliance within a complex and rapidly evolving regulatory environment.
This role is instrumental in establishing a best in class compliance department and have the tactical skills to execute on the departmental needs through system integration, policy establishment and results monitoring.
WHAT YOU’LL DO:
Perform federal and state regulatory research proactively anticipate business needs and requirements, identify and communicate potential risks/needs to key stakeholders, develop policies and procedures as well as strategic plans to mitigate risks and address needs
Specific to business registration and licensure requirements, routinely conduct and monitor state and federal regulations, in addition, prepare, file and manage business registrations and licenses including the submission of required reporting
Partner with department leads to ensure compliance with all statutory and regulatory requirements, pharmacy compliance activities and PBM compliance initiatives across the business; develop and maintain department approved regulatory and legislative compliance plan; create, implement, and maintain effective internal controls including policies and procedures
Partner with department leads to ensure terms and conditions within vendor and client contracts as well as other pertinent agreements comply with applicable state and federal regulations
Track, monitor and communicate across departments i) policies and procedures; ii) performance and reporting requirements; and iii) key metrics
Participate as compliance subject matter expert on all mandated projects and escalated matters; achieve business operational compliance with all related measures relative to PBM accreditation initiatives
Maintain an understanding and knowledge of regulatory affairs in all applicable jurisdictions and regulatory environments; lead and facilitate the development of company positions as well as internal and external responses related to pending regulatory initiatives
Develop and implement training and communication plans; manage and lead scheduled and ad-hoc compliance projects; provide and deliver compliance consultation services to all departments
Provide strategic compliance leadership and guidance to Rightway clients and business partners, fostering a culture of compliance, regulatory accountability, and operational excellence.
Promote continuous improvement of regulatory programs and initiatives by identifying opportunities for improvement; work with key stakeholders across departments to design and implement regulatory process improvement programs and initiatives; and develop recommendations
Conduct, direct, lead and facilitate all activities related to Internal and External (Regulatory and Client) audits and responses to findings
Lead, mentor, and develop a team of compliance professionals and people leaders through coaching,performance management, succession planning, and talent development.
WHO YOU ARE:
Education level: Bachelor’s Degree Required (Preferred: Master’s Degree) and JD (Juris Doctorate) degree or equivalent combination of practical experience
Work experience: Minimum 7 years of relevant work experience in the healthcare industry with PBM industry experience preferred
Important characteristics of ideal candidate: Detail-oriented, analytical, intellectually curious, good listener, empathetic, ability to challenge status quo, values exemplar
Specific skills needed for job: Solid communication, research and organizational skills, ability to lead projects and influence others even without direct reporting line ownership
Ability to work independently and manage multiple projects in a fast-paced, fluid environment
Advanced computer and Windows skills required
COMPENSATION: $185,000 - $220,000 annually, in addition to bonus and equity
Compensation offered will be determined by geographic location, experience, and qualifications.