Specialist, Pharmacy Compliance

HealthPartners is hiring a Pharmacy Compliance Specialist. This position works with pharmacy leaders to develop and implement monitoring tools that ensure compliance, performance standards and audit readiness. The position will also maintain accountability for the maintenance of the content of Pharmacy Admin Policies and Procedures, including developing and ongoing review to ensure compliance with current regulatory and accreditation standards. The position provides timely and effective feedback and ensures quality of departmental documentation via auditing. This position will also support Pharmacy Administration and other departments in responding to external and internal regulatory and compliance audits. The position will identify areas for operational improvements and assist in monitoring corrective action plans.

MINIMUM QUALIFICATIONS:

Education, Experience or Equivalent Combination:

o Bachelor's Degree or equivalent experience

o Two years' experience with government programs, in a regulatory environment or in an HMO/health care industry

Knowledge, Skills, and Abilities:

o Demonstrated comprehensive, in-depth knowledge, of regulatory and accreditation compliance requirements, with ability to interpret standards and implement processes accordingly

o Expertise in working collaboratively and communicating with staff in different positions and all levels of management positions

o Program management experience

o High degree of initiative and ability to work independently and within a group

o Solid written and oral communication skills

o Excellent computer skills including Microsoft Word, Outlook, Power Point, Excel

o Excellent technical and business writing and editing skills with a focus on policy and procedure writing

o Effective work history with range of internal and external customers

o Excellent follow through and problem-solving skills and attention to detail

PREFERRED QUALIFICATIONS:

Education, Experience or Equivalent Combination:

o Direct work experience with government programs and regulatory matters

o Experience working with Compliance 360 monitoring tool

o SharePoint and OneNote experience

Knowledge, Skills, and Abilities:

o Knowledge of HealthPartners

o Knowledge of HealthPartners systems and applications

ESSENTIAL DUTIES:

(65%) - Support Functions for Department Compliance

• Develops and maintains Pharmacy Admin Policies and Procedures and ensures compliance with current regulatory and accreditation standards
• Works closely with the other pharmacy staff to assure that training, procedures, task lists and processes support policies, department needs, and regulatory and accreditation standards
• Participates in and/or effectively leads various workgroups, and projects as needed and assigned
• Communicates progress of monitoring program and issues for resolution to Compliance Manager and Manager of Pharmacy Benefits
• Advises the Compliance Manager of potential compliance issues in various government programs
• Develops and executes monitoring and compliance activities with project management tools and approaches

(30%) - Audit/Compliance and Reporting

• Develops and maintains audit tools, assists in creating reports and presents summaries to key stakeholders, recommending corrective action and follow up
• Supports regulatory and accreditation audits including universe file pulls, file preparation and submission of documentation as needed
• Participates in or lead audits and audit-related activities as required by NCQA, MDH, CMS, etc.

(5%) - General Performance/Knowledge

• Maintains appropriate confidentiality of information in accordance with HealthPartners corporate policies
• Participates in ongoing independent study and education to develop and maintain knowledge in the areas of applicable software systems, regulatory and accreditation standards, quality improvement strategies and compliance requirements
• Demonstrates responsiveness to and appreciation of constructive feedback and recommendations for personal growth and development
• Performs other duties as assigned

MAJOR CHALLENGES:

• Responsible for the coordination and implementation of daily program management activities for Government Programs monitoring programs
• Needs to balance and manage demands of our customers (regulatory agencies, business partners with internal operational concerns, review staff) and quality and performance standards
• Facilitate interdepartmental compliance with program requirements
• Key resource for internal and external contacts on program administration
• Keep leadership and key partners informed of problems, concerns and trends that arise
  
  
  
  • Processing of regulatory, contractual and operational considerations before giving direction to staff on program compliance
  
  

DECISION-MAKING:

• Makes independent decisions regarding select operational details
• Confers with the Monitoring and Compliance Manager of Government Programs and other managers on material/significant policy or regulatory changes