This position will assist leadership in implementing and administering the Medicaid Magellan Administration (\"MMA\") Medi-Cal Rx Program Integrity Plan that governs Magellan's prescription drug and pharmacy benefit management services ensuring overall compliance with applicable laws, regulations, and guidelines.
Assists with the risk assessment process and Compliance audit work plan implementation to identify compliance issues, as well as an evaluation process that demonstrates the effectiveness of such efforts.
Serves as the subject matter expert, regarding Conflicts of Interest, including answering questions, reviewing and approving all compliance related aspects regarding Organizational Conflicts of Interest (OCIs) and Conflicts Of Interests (COIs) and the existing Form 700 COI protocols.
Manages all processes, including domain access approvals and ongoing updates on user access to Medi-Cal data, including reporting to the Department of Healthcare Services (DHCS).
Provides guidance in the developing and implementing policies and procedures relevant to Magellan's prescription drug and pharmacy benefit management services.
Provides regular reports to appropriate leadership and MMA Chief Compliance Officer regarding the overall effectiveness of the Medi-Cal Rx Program Integrity Plan, including remediation efforts to resolve identified compliance issues.
Coordinates with the Training Department to develop education and training programs to ensure that Medi-Cal Rx complies with applicable statutory, regulatory, and other standards as well as completions of annual Code of Conduct training.
Maintains an effective communication program with operational areas to ensure employees have a heightened awareness of program integrity expectations regarding OCIs and COIs, new and existing issues, and related policies and procedures.
Responsible for providing guidance and overseeing organizational compliance with CMS guidance, transmittals, Department of Health Care Services (DHCS) notices, and CMS required submissions.
Implements a robust Compliance audit program to include First Tier Downstream Related Entity (FDR) oversight and identifies trends and recommends corrective action to the MMA Chief Compliance Officer.
Monitors corrective action plans to ensure compliance and ensures attestations as well as annual reporting is completed.
Assists with establishing a system for tracking, investigation, and documentation of identified compliance and FWA issues (including through coordination with the SIU).
Coordinates with the Corporate Compliance department to ensure that DHHS OIG and GSA exclusion lists have been checked for all employees, governing board members, and FDRs.
Works with MMA's Medi-Cal Rx Privacy Officer in administering the Company's HIPAA and state law privacy program at SBU sites.
Leads and oversees resources and staffing allocated for the Problem Correction Process.
Ensures all employees exiting, externally or internally, are reminded of their confidentiality requirements and their COI obligations.
Serves as the point of contact for Security Information and Event Management (SIEM) monitoring reports and investigations.
Other Job Requirements
Responsibilities
Experience working for a managed care company or other health related organization, strongly preferred.
An individual who is able to work independently.
Strong interpersonal, organizational, research and writing skills; attention to detail.
Ability to coordinate and integrate information from diverse operational areas into a written product.
Excellent verbal and written communication skills.
8+ years of experience with at least 5 of those years in healthcare or managed care/ compliance experience.
General Job Information
Title Government Liaison - Remote Opportunity!
Grade 29
Work Experience Healthcare, Legal
Education Bachelors (Required), Masters
License and Certifications - Required
License and Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
