Legal Compliance Advisor - Medicare Part D/ Rx Service Operations
Medication Therapy Management (MTM), Formulary, Drug Utilization Review (DUR), Opioid Edits, Pharmacy & Therapeutics (P&T), End Stage Renal Disease (ESRD/ Hospice, Fraud, Waste and Abuse (FWA,) and Clinical Decision Making Role Summary
The Medicare Part D Legal Compliance Advisor is responsible for compliance support of service operations with specific focus on Medicare clinical programs. The Advisor will ensure operational compliance with all regulatory requirements and standards relative to Medicare Part D in assigned areas of oversight. A candidate for this position must promote an enterprise-wide culture of compliance by maintaining open lines of communication with business partners and compliance peers. This individual will represent compliance in such a way that ensures (i) all Medicare Part D regulatory requirements are understood, (ii) business processes required to address those requirements are implemented, (iii) compliance risks are communicated to the Legal Compliance Senior Manager and appropriate business leads, and (iv) oversight and approval of compliance related issue corrective actions are executed timely, tracked in accordance with department procedures, and escalated as needed . Additionally, this role will support service operation related audits and assist in corrective action plan identification, creation, and closure. Responsibilities Report to the Senior Manager of Medicare Part D Compliance - Medicare Business Support Act as a subject matter expert (SME) to interpret and ensure Medicare regulations have been implemented timely and accurately both internally and by assigned First Tier, Downstream and Related Entities (FDR) Act as a SME in the management of Corrective Action Plans (CAP) and other issue remediation for function specific Part D and FDR related issues. Partner with the monitoring teams (Business & Compliance) to provide input and development of the program, adopt new strategies, and execute correction of issues. Support other areas of Part D and FDR related issues as needed. Develop strong working relationships with internal leaders to ensure open lines of communication and timely responses to compliance questions. Liaise with various members of the Compliance organization and the business. Perform other duties as assigned. Qualifications RPh or PharmD required. Minimum of three to five years of related experience with Medicare Part D required; Compliance experience. Expertise of clinical program operation and regulations experience preferred. Attention to detail and analytic skills required. Strong oral and written communication skills required.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 91,900 - 153,100 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group . About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
