Cigna Governance Risk Regulatory Compliance Advisor in St Louis, Missouri

Description:

The Pharmacy Compliance Sr. Specialist support the Pharmacy Compliance Manager and Cigna’s PBM/Pharmacy Compliance team in implementing an effective compliance program for Cigna's Pharmacy businesses, including its specialty pharmacy, home delivery pharmacy, and pharmacy benefit manager functions. The Compliance Sr. Specialist will provide ongoing regulatory support to ensure that the PBM and pharmacy segments are in compliance with all federal and state regulatory requirements governing the practice of pharmacy and sale of pharmacy benefit management services, including (but not limited to) activities regulated under the following laws: state pharmacy practice acts, professional licensing regulations, insurance acts, controlled substances act, Food and Drug Act, and federal fraud and abuse laws (anti-kickback, stark, civil monetary penalty, etc.) . The Compliance Sr. Specialist will assist, support, develop and promote a culture of compliance and an understanding of new and existing compliance issues and related policies and procedures for a heavily regulated healthcare services company.

  • Provide day to day regulatory support to the PBM/Pharmacy compliance function and to assist with the evaluation and intake of new laws, regulations, and regulatory guidance impacting Cigna's provision of pharmacy benefit services;
  • To develop and help draft policies, procedures, executive memorandums, analysis, and presentation materials related to the regulatory issues impacting Cigna's pharmacy and related ancillary businesses dealing with the drug benefit it sells to clients and customers;
  • To assist the Pharmacy Compliance Manager and other teammates with the development of risk assessments, audit plans, corrective action and remediation plans, and quarterly reports;
  • Help to develop and ensure ongoing compliance with the Enterprise Compliance program, Privacy, Information Protection and Records Management programs.
  • Follow up on audit reviews and approve implementation standards based on passed legislations that are now regulated and have operational controls embedded in the business that warrant compliance monitoring;
  • Assists in responding to alleged violations of rules, regulations, policies and procedures, by evaluating or recommending the initiation of investigate procedures. Partners with leadership and the Enterprise Compliance Team to maintain a system for uniform handling of such violations.
  • Collaborates with internal and externals parties to develop positive and proactive approaches to regulatory compliance;
  • Ensures that deadlines are maintained and closely monitors the need for extensions to be administered in relation to audits, regulatory and mandates requirements in order to maintain compliance in this area
  • Provide project management support, including creating projects management tools, to organize, track and manage complex legal and compliance initiative
  • Provide reports on a regular basis to keep the key business stakeholders and compliance leadership informed of the operation and progress of compliance efforts
  • Responsible for supporting Pharmacy Compliance Manager by responding to inquiries, prioritizing issues, answering questions and advising, or referring situations requiring immediate attention to the appropriate departments including partners in the Cigna legal function when needed for final legal advice.

Qualifications:

  • A Juris Doctorate is preferred;
  • Knowledge of or a certification in healthcare compliance or other applicable areas related of experience in a healthcare services company or heavily regulated industry;
  • Ideal candidate will have 2-3 years of legal, compliance, or regulatory experience or other relevant work experience (law firm or government experience preferred; in-house also acceptable);
  • Working knowledge of healthcare laws or regulations or evidenced experience to learn heavily regulated industry;
  • Excellent written skills to support the creations of new business policies, regulatory analysis, and policies and procedures that would support a compliance program;
  • Demonstrated ability to support creating solutions to complex business and legal problems;
  • Highly collaborative individual with the ability to influence other and builds strong personal relationships with the legal department, other elements of the compliance program, the government affairs department, and the business as needed;
  • Ability to interact with state and federal regulators as directed by management or colleagues in legal and government affairs;
  • Demonstrated good judgment and willingness to take on challenging projects;
  • Excellent organizational, verbal, and time management skills;
  • Ability to lead and coordinate important projects, services, or processes (such as review of regulatory enactments);
  • Ability to present to senior leadership on significant topics;
  • Proficient in Microsoft Office Products;

Primary Location: St Louis-Missouri

Other Locations: United States-Connecticut-Bloomfield, United States-Pennsylvania-Philadelphia, United States-Minnesota-Eden Prairie

Work Locations: 900 Cottage Grove Road Wilde Bloomfield 06152

Job: Legal--Compliance

Schedule: Regular

Shift: Standard

Employee Status: Individual Contributor

Job Type: Full-time

Job Level: Day Job

Travel: Yes, 25 % of the Time

Job Posting: Sep 18, 2018, 1:16:02 PM

Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: SeeYourself@cigna.com