Vice President, PBM Compliance, Regulatory Operations

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Develop and establish the Compliance Function.

• Manage and upkeep a comprehensive regulatory inventory and monitoring process on a state-by-state basis.

• Collaborate with operations and technology teams to implement requirements across various areas including claims adjudication, MAC pricing, pharmacy network standards, and appeals processes.

• Maintain a continuous state of readiness for market conduct examinations.

• Conduct internal reviews and mock examinations to ensure preparedness.

• Design and execute system-based compliance controls and automated edits within PBM platforms.

• Supervise PBM responsibilities in accordance with the Consolidated Appropriations Act (CAA).

• Provide executive leadership for the organization’s HIPAA Privacy, Security, and Breach Notification compliance initiatives.

• Act as the executive lead for HIPAA-related incidents, managing intake, investigation, risk assessment, and breach determination processes.

• Function as a hands-on leader, directly responsible for key deliverables during the initial phases.

• Build and expand the compliance team over time.

• Deliver regular reports and insights to executive leadership.

⛳️ Requirements

• Bachelor’s degree (B.A.) in Law, Healthcare Administration, Business Administration, Public Health, Pharmacy, or a related field, or 2+ years of relevant experience and/or training; or an equivalent combination of education and experience.

• High level of professional ethics and integrity.

• Strong judgment and the ability to analyze situations and information effectively.

• Juris Doctor (JD) or a similar legal background is highly preferred.

• Over 10 years of experience in healthcare compliance, PBM, health plan, or a similarly regulated environment.

• Proven track record of implementing regulatory requirements into operations, systems, or workflows.

• In-depth knowledge of state PBM laws or similar multi-state regulatory frameworks.

• Experience in supporting market conduct examinations, audits, or regulatory reviews.

• Demonstrated ability to collaborate across various functions including technology, operations, legal, and finance teams.

🏝️ Benefits

• Medical, Dental, Vision insurance.

• Disability and Life insurance.

• Employee Assistance Program.

• Options for remote work.

• Generous Paid-Time Off.

• Annual Reviews and Development Plans.

• Retirement Plan with company match, with immediate 100% vesting.