Director of Compliance and Contracting (Remote)

Clarest Health is a nationally recognized, technology driven provider of institutional pharmacy services operating in over 40 states. As a mission-driven pharmacy health expert, Clarest Health offers an end-to-end, patient-centered medication management solution to support patients in optimizing, accessing, and adhering to, their medication regimen. Our flexible, comprehensive services integrate technology, human engagement, and proven processes to advance patient health at every step while enabling our partners to achieve better business outcomes.

We are seeking a Director of Compliance & Contracting to lead our compliance program and manage contracting activities for our Diversified Services division. The Director of Compliance & Contracting will ensure that the Diversified Services compliance program meets Medicare Parts C & D (Medicare Advantage Organizations & Medicare Prescription Drug Plans) requirements applicable to First Tier, Downstream, and Related Entities (FDRs) and other customer contractual requirements. The Director of Compliance & Contracting will review, draft, manage, and monitor contracts in collaboration with internal stakeholders and the legal team.

Location: Remote

Salary: From $95,000/year, based on experience and skills

Travel: up to 20%

Reports To: Chief Legal Officer

What We Offer:

·           Comprehensive Medical, Dental and Vision Insurance (as low as $13.33/pay)

·           Paid Time Off

·           Free Virtual Care – Telemedicine

·           401k with company match

·           Life Insurance

·           Make a difference in the lives of others!

·           We are growing and that means more opportunities

Key Responsibilities:

·           Maintain an effective compliance program and its related policies, procedures, processes, and activities in accordance with Medicare Parts C & D requirements applicable to First Tier, Downstream, and Related Entities (FDRs) and customer contracts

·           Ensure timely completion of compliance training, conduct and/or document background checks, drug screening, exclusion screening, and conflict of interest screening in accordance with regulatory and contractual requirements

·           Maintain a compliance incident reporting and management system and remediate identified compliance deficiencies, including developing, implementing, and monitoring corrective action plans as required by customers 

·           Respond to customer auditing and monitoring activities and conduct external auditing and monitoring activities of any downstream entities or vendors

·           Review, draft, negotiate, manage, and monitor contracts, amendments, addendums, and statements of work, in collaboration with internal stakeholders and the legal team. Prepare contract status reports for stakeholders and communicate contract updates to relevant parties

·           Review existing and proposed contracts, RFPs, and proposals related to regulatory compliance requirements to gain understanding of requirements and implement necessary compliance measures

·           Review and negotiate Business Associate Agreements with HIPAA covered entity customers and partners and work closely with Chief Information Security Officer regarding related security obligations

·           Develop and maintain an oversight and monitoring program for downstream entities, as well as vendors that have access to Protected Health Information, and collect any required compliance attestations from same. Ensure that downstream Business Associate Agreements are implemented in accordance with HIPAA and customer requirements. Establish and maintain oversight of any offshore vendors in compliance with contractual requirements

Qualifications:

·           Bachelor's degree in Business, Healthcare Administration, Legal Studies, or a related field

·           5 – 7 years of experience in healthcare compliance, contract management, or regulatory affairs, preferably within PBM, or healthcare organizations

·           Strong understanding of health care compliance regulations, including Medicare Parts C & D and FDR requirements

·           Experience reviewing, and drafting complex contracts, amendments, and statements of work

·           Ability to interpret and apply Medicare regulations, compliance program provisions, and evolving legal requirements

·           Prior experience with health plan contracting and managing compliance programs for downstream entities and vendors highly preferred

Skills + Abilities:

·           Strong ability to interpret legal documents, regulatory requirements, and compliance frameworks

·           Excellent written and verbal communication skills for engaging with cross-functional teams, clients, and leadership

·           Strong analytical skills to assess risks, resolve compliance issues, and implement corrective actions

·           Ability to manage multiple priorities, deadlines, and compliance initiatives effectively

·           High accuracy in reviewing contracts, monitoring compliance risks, and maintaining regulatory standards

Clarest is an Equal Opportunity Employer. Reasonable accommodations will be made to enable individuals with disabilities to apply for a job or to perform the essential functions of their job. Please advise us if you require a reasonable accommodation.