Oversight And Compliance Officer Jobs

Experience within Healthcare, Pharmacy Benefit Management (PBM), and/or Insurance industries.

Experience in Pharmacy Benefit Management (PBM) within Quality Assurance or Configuration.

Collaborate with the Prescription Drug Event (PDE), Quality Action Notice (QAN), Audit and Regulatory Committee Management (RCM) when requested.

Collaborate in the development of new logics and procedures to improve processes in your areas of responsibilities.

Write and update policies and procedures in your areas of responsibilities.

Review prescriptions and other auditable documents to verify compliance with Centers for Medicare & Medicaid Services (CMS) requirements and contractual requirements.

Excellent planning, time management and coordination skills.

6+ years’ experience in monitoring and site management of industry sponsored clinical research (CRA, Clinical Trial Monitor, or equivalent).

excellent planning, time management and coordination skills.

Addresses issues identified with study conduct, monitoring and site management with Sponsor’s management, are appropriately communicated/escalated and follows up through resolution.

Demonstrated management of monitoring and site management tasks.

The ability to identify, solve and escalate issues that arise at study sites and within site management

Manages and evaluates operational efficiency. Sets measurable standards leveraging internal and external resources accordingly.

Minimum of eight years related work experience. Supervisory experience preferred.

Undergraduate degree or equivalent combination of training and experience.

Strong process background and organizational skills

Vanguard is not offering visa sponsorship for this position.

Oversees the implementation of compliance controls to ensure gaps are closed.

Utilization Management and/or Case Management experience strongly preferred.

Preferred Skills, Capabilities And Experiences

Assists with planning and implementation of formal education sessions to external customers to address non-compliance issues.

Job Family: Medical and Clinical

Performs annual and ad hoc delegation oversight audits and internal health plan functional unit audits.

Develops corrective action plans and analyses of required program reports and internal performance measures.

Preferred Skills and Abilities: Knowledge of current trends and industry best practices.

Required Education: Bachelor's degree in Business, Healthcare, Accounting, Finance, or other job-related field

Preferred Education: Master's degree in Business, Healthcare, Accounting, Finance, or other job-related field

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

Required Software and Other Tools: Microsoft Office

Work Environment: Typical office environment. Some out of town travel. Some travel between office buildings.

Strong critical thinking and analytical skills; results driven with ability to creatively problem solve

Proficient with Microsoft Office (Excel, Word and PowerPoint); Skilled in the use of Bloomberg

Excellent verbal, written and presentation communication skills

Has flexibility to work independently while valuing the benefits of influencing a true team effort

Equivalent to Bachelor's degree in Accounting, Finance, Business or relevant field

5+ years related experience, with direct experience in valuation operations and/or oversight

Maintains a record of ongoing cases of alleged fraud or misuse of funding in the context of Country-Based Humanitarian Pooled Funds.

Organizes and participates in work groups, meetings, conferences, consultations with other agencies and partners on humanitarian and emergency relief-related matters.

Performs other duties as required.

Working with internal stakeholders to follow identified processes, procedures, and salesforce management of marketing campaigns.

Remote work: Enjoy the convenience of working from home and maximize your time by unplugging at the end of your workday.

Shows 10 years of marketing or events marketing experience.

Experience with payment processing helpful

Health and Welfare Benefits Retirement Savings

Manager, Marketing Events Strategy and Oversight