Director Contract & Compliance - PBM
Elevance Health

Director Contract & Compliance - PBM

Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our PulsePoint locations.

The Director Contract & Compliance - PMB is responsible for maintaining a formal compliance structure to meet enterprise-wide contract and compliance requirements in our Local Markets. The Director will oversee a team that managing the lifecycle of a PBM contract from beginning to completion., including the contract approval process.

How you will make an impact:

• Develops and manages staff responsible for the member certificate and employer policy (contract) materials for products and services.
• Manages and oversees the full end to end contracting process for PBM clients, including of drafting of contracts and amendments, ensuring version control, managing deadlines, obtaining internal approvals and overseeing the execution process.
• Manage team of contract managers and 340B legal analyst.
• Draft and negotiate new contracts, contract renewals, amendments and other contractual documents (e.g., LOI, LOA) with PBM clients.
• Communicate contract deliverables to the respective operational areas, including leadership, and obtain proper approvals from internal business areas and stakeholders.
• Work with internal stakeholders, external clients and consultants in support of PBM contracting initiatives.
• Partner with internal stakeholders to drive value and efficiency in the contracting process.
• Establish priorities, coordinate and monitor workflow, and implement standardization where possible, including creation of an alternate provision tool with preferred, accepted and discouraged alternates.
• Maintain contract templates while developing and overseeing contract approval process and non-standard and exception contract language approvals.
• Manage and negotiate non-disclosure agreements associated with third party requests for release of data containing confidential information, requests from third parties to audit contract terms and requests as part of RFPs.
• Review RFP responses for potential PBM clients under 5,000 lives to ensure compliance with contractual terms, company's position and market competitiveness.
• Provide quality control, interpret contract language, research and resolve contract process template inquiries and issues.
• Maintenance of records of contracts and other related documents.
• General research, contract administrative management and other related work as requested.
• Assist with ad hoc items and/or engage in special projects as requested by leadership.
• Reviews policy language and marketing and retention materials for compliance with state and federal regulations and for consistency between collateral materials and contracts.
• Manages all Department of Insurance/regulatory filings to ensure they meet local state and federal regulatory requirements.
• Establishes relationships with local regulatory body and has open dialogue to resolve issues regarding filings. Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

Requires a BA/BS in a related field and minimum of 8 years experience in contract/certificate writing, legal research and analysis and regulatory oversight in the healthcare industry; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

• Mastery of contract and business writing to ensure regulatory compliance and consumer comprehension strongly preferred.
• Knowledge of health care products, state and federal regulations in the health care industry, funding arrangements in the Group Market, and proven ability to analyze and integrate highly technical information into action plans strongly preferred.
• Ability to prioritize, attention to detail, and the ability to work on multiple tasks simultaneously while meeting deadlines is imperative preferred.
• Training in the legal field and/or contracting experience preferred.
• Excellent verbal and written communication skills preferred.
• Ability to research and summarize information preferred.
• Strong documentation skills preferred.
• Strong interpersonal skills, with demonstrated ability to lead and contribute to a team effort while also being able to work independently preferred.

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