Senior Director/VP, Corporate Compliance

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

About Capital Rx:

Capital Rx is a next generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology and service is the reason why Capital Rx is among the fastest-growing PBMs in the country.
Position Summary:

The Senior Director/VP, Corporate Compliance, reporting to the Chief Compliance Officer, will provide operational leadership pertaining to compliance and regulatory issues as well as manage an enterprise wide comprehensive compliance program, including ,but not limited to a Medicare Part D Compliance Program. The actual position title will depend on the experience level of the successful candidate. The role, working closely with the Chief Compliance Officer, will help oversee and lead the development of a compliance risk management program to assess, prioritize, and manages regulatory compliance risks based on state/federal guidelines and requirements and bench marking research, facilitating the systematic assessment and management of compliance risks. The role is also responsible for enterprise-wide confidential reporting systems allowing employees, customers, contractors, and other stakeholders to disclose violations of the corporation's ethical standards, violations of law, or corporate policy relating to such matters without fear of retaliation.
Position Responsibilities:

• Responsible for development, implementation and ongoing refinement of enterprise-wide strategies for an effective compliance, ethics and integrity and privacy/security program. Oversight of a robust Medicare Part D Compliance Program
• Provides leadership and oversight of compliance monitoring and auditing activities (i.e., compliance assurance program), including any action plans and/or commitments made by enterprise
• Develops, directs and maintains responsibility for the corporation's compliance function and business ethics related to standard of conduct, including HIPAA privacy and security compliance
• Reviews the content and performance of the Corporate Compliance Program including Medicare Part D, compliance policies and procedures, and the Corporate Code of Business Conduct and Ethical Behavior on a routine basis; takes appropriate steps to ensure its effectiveness to prevent, detect and correct illegal, unethical, or improper conduct within the corporation
• Manages any investigations of alleged violations of law, policies and procedures, and the Company’s Code of Conduct in consultation with the Vice President of Legal, and/or designated outside legal counsel, and takes appropriate corrective action
• Oversees the development, implementation and maintenance of an effective compliance communication and training program for the enterprise, subsidiaries and affiliate entities
• Coordinates with various departments, such as Legal, Human Resources, Operations and other departments as required, and include appropriate introductory compliance training, as well as ongoing training on compliance related topics as needed
• Provides real-time guidance to business units and subsidiaries related to multiple potential compliance issues
• Manages the Enterprise URAC Accreditation process, on-going requirements and the annual re-accreditation process.
• Effectively translates regulatory guidance into streamlined operational processes to ensure compliance, at times with short notice
• Oversees the development and operation of compliance monitoring and auditing (i.e., compliance assurance program)
• Receives regular reports and assists in the development of corrective actions
• Serves as Chair for the Corporate Compliance Committee, which serves in an advisory capacity, and keeps senior management informed on the operation and progress of the organization’s compliance efforts
• Designs and implements programs, policies, and practices to ensure that all business units are in compliance with federal, state, and local regulatory requirements
• Tracks laws and regulations that affect the organization's policies. Prepares compliance reports for presentation to the Board of Directors and executive management
• Directs the coordination and completion of all government, regulatory, and compliance documents on an enterprise level and oversees the acquisition and maintenance of required licenses and certificates from appropriate state and federal entities
• Provides day to day management of the department (directly and through subordinate managers) including developing and managing the department’s budget
• Recruits, manages, develops and retains the necessary resources to successfully perform the Corporate Compliance function

Required Qualifications:

• Bachelor’s degree in Business, Health Care, or related are of study required. Advanced Degree preferred.
• Certified Compliance and Ethics Professional or Certified in Healthcare Compliance (CHC), or agreement to obtain within first 1-2 years of employment.
• 5+ years of job related & management experience in the PBM/Health Plan environment. Candidates with other healthcare experience (health plans, state Medicaid plans) may be considered.
• Compliance experience at a national level is preferred and experience with Medicare Part D.
• 3+ years of HIPAA compliance expertise and prior responsibility as a Privacy Officer and/or Security Officer preferred.
• Experience with broad spectrum PBM offerings and associated potential regulatory issues.
• Knowledge of Medicare/Medicaid and related healthcare rules and regulations, such as third-party administrators and utilization review.
• Ability to lead and facilitate group meetings as well as experience presenting to senior leaders of the organization.
• Self-starter with the ability to define, coordinate and direct assignments of team members.
• Proficiency with Microsoft Office/Outlook & industry-related databases.
• Excellent interpersonal, collaborations, communication, (verbal and written) and presentation skills essential.

Base Salary: $140,000 - $185,000

This range represents the low and high end of the anticipated base salary range for the NY - based position. The actual base salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes. 

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.