Manager of Compliance and Clinical Operations

Overview

Scope of Responsibilities:  Responsible for all regulatory, compliance, and accreditation matters within HealthDirect. Oversees the development, and overall maintenance of all HealthDirect policy and procedure. Responsible for the overall management of the clinical team and corresponding policy, procedure, and programs.

Job Summary:  Reporting to the Director of Operations, the Manager of Compliance and Clinical Operations is responsible for maintaining an effective compliance program to ensure that HealthDirect services are provided in compliance with all laws, regulations, and accreditation standards pertaining to its state licensure, third party administrators, utilization review and management requirements. The Manager of Compliance and Clinical Operations will also have oversight of HealthDirect’s clinical operations and will be responsible for ensuring that clinical standards are strictly managed and adhered to at HealthDirect.

Responsibilities

• Partners with internal and external legal resources as needed to resolve compliance issues.
• Keeps apprised of new regulatory developments by reviewing regulatory publications and applicable industry trade publications.
• Oversees the issuing of new licenses, licensing renewals, and reporting requirements for regulatory changes and updates.
• Track applicable legislation/regulation, analyze impact on company, and communicate relevant information to the organization.
• Participate in development and implementation of initiatives to improve processes and procedures.
• Acts as liaison for Boards of Pharmacy and related overseeing authorities throughout US
• Oversee the development, implementation, and execution of all elements of accreditation standards.
• Acts as a channel of communication to receive and direct compliance issues to appropriate resources for investigation and resolution of claims adjudication issues.
• Ensures that activities are conducted according to the policies and procedures of HealthDirect.
• Supports HIPAA compliance efforts to ensure policies and procedures are appropriate to meet HIPAA requirements and identifying operational obstacles to compliance and working with other employees to identify and implement solutions.
• Responsible for legal compliance with state and federal laws.
• Interface with various auditors and outside agencies, as needed.
• Responsible for all aspects of Clinical Operations at HealthDirect.
• Responsible for the development, and management of the consultant pharmacists.
• Responsible for completing all mandatory and regulatory training programs.
• Perform other duties as assigned.

Qualifications

Education:

• Minimum: BS in Pharmacy
• Preferred: Pharm D with consulting experience

Experience:

• Minimum 5 years in pharmacy, regulatory or compliance role
• Requires strong understanding of the LTC space and ability to interpret regulatory and legal documents.
• Work with a high degree of autonomy, but able to successfully collaborate and build relationships with colleagues in a distributed work environment.

Compensation:

$65,000 - 71,000 per year.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education. 

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.