Senior Manager, Government Programs 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 Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change.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 Responsibilities:

• Oversee prescription drug benefit management compliance for government and/or regulated lines of business (Health Insurance Marketplace, Medicare, and Medicaid)
• Work closely with the executive team and other key leadership stakeholders
• Support operational business areas in ensuring compliance with applicable requirements including federal and state laws, regulations, guidance, orders, bulletins, and other items of general compliance
• Partner with business areas to create, maintain, and/or improve effective, accurate, and efficient business processes
• Develop and support Regulatory Change Management (RCM) processes across all lines of business
• Track, analyze and interpret laws, regulations, standards, and guidance (e.g., HPMS Memos) for dissemination and oversight of implementation by applicable business areas
• Maintain current knowledge of regulated lines of business to support compliance of ongoing business operations
• Oversee First Tier, Downstream, and Related Entities (FDRs) including attestations, auditing, monitoring, and corrective action plans
• Develop internal and external compliance communications or other materials for regulated lines of business
• Conduct, maintain, and report ongoing compliance risk assessment activities
• Investigate compliance issues including corrective action plan review, approval, oversight, and reporting
• Build and maintain trusting relationships with internal and external stakeholders through service delivery excellence and oversight
• Other compliance duties as assigned by the Compliance Officer

Required Qualifications:

• Bachelor’s degree in business, healthcare, or related field (Extensive work experience may be considered in lieu of degree(s))
• 8+ years of PBM and/or health plan experience in a compliance department, or in an operational compliance role, with focus in government and regulated lines of business
• Demonstrated track record of leveraging deep understanding of government lines of business requirements, industry standards, and forecasting
• Proven success in translating complex legal requirements to operational policies and procedures
• Experience with internal and/or external audit support, including but not limited to, CMS Program Audits
• Executive, regulatory, and client presentation and communication experience including complex compliance and legal communication
• Track record of leading complex, cross-functional initiatives, driving high performance, meeting deadlines, and executing on deliverables
• Exceptional written and verbal communication skills
• Extremely flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product

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.