Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 600,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.
UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job. Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 13 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
SENIOR AUDITOR - PHARMACY
Work Location: Work from Home or Office for Your Day
As the Pharmacy Senior Auditor, you will be responsible for auditing and assessing risks towards compliance with laws, regulations, government contracts and policies that govern prescription drug programs for Medicare Part D, Medicaid and Exchange lines of business. In addition, you will audit for operational risks and other non-pharmacy-related audits, as needed. Conduct risk assessments and audit/monitor activities related to UCare's prescription drug program to ensure risk areas are identified and appropriately mitigated.
• Assist in the development and implementation of UCare's compliance program, including risk identification and mitigation, and assessing and supporting efforts to enhance program effectiveness.
• Develop and implement monitoring activities of internal business units and UCare's Pharmacy Benefit Manager (PBM) based on risk identification and an annual compliance monitoring schedule developed in coordination with the Audit Director, other team members and appropriate oversight committees. Communicate annual schedule to internal stakeholders and UCare's PBM.
• Conduct internal compliance reviews related to UCare's prescription drug program and coordinate and lead the annual audit of UCare's PBM. Deliver findings to internal and external stakeholders, including oversight committees, and oversee the development and implementation of corrective action plans to address findings.
• Develop and maintain audit tools that incorporate the regulatory and contractual requirements to be used during compliance reviews and the annual audit of UCare's PBM.
• Develop and maintain reporting tools to effectively capture the compliance review findings and monitoring activities related to UCare's prescription drug program. Routinely assess the effectiveness of reporting tools. Report results to the Audit Director and other leaders as requested.
• Assist the Audit Director in preparation of periodic reports for review by management, the Compliance Oversight Committee and Compliance Committee of the Board. Participate in the Compliance Oversight Committee, as needed.
• Assist the Audit Director in the development and maintenance of policies and procedures to support an effective compliance program.
• Assist UCare's Special Investigations Unit, as needed, in assessing compliance with federal and state fraud, waste and abuse program requirements as they relate to UCare's PBM.
• Collaborate with other departments on prescription drug benefit contract issues and responding to regulatory guidance, including assisting in the preparation and response to any regulatory inquiries or audits.
• Oversee, direct, deliver, or ensure delivery, of any required training related to prescription drug benefit compliance issues to UCare employees, PBM employees, and UCare's applicable downstream entities.
• Other audits, projects and duties as assigned.
Bachelor's degree required in business, health care administration, health policy or related field.
Five years related experience with at least three years in health care compliance or pharmacy operations. Previous state or federal regulatory or managed care compliance experience, preferably including Medicare Part D related experience.
Two years experience conducting internal audits or compliance reviews. Experience in pharmacy benefits management.
THE UCARE DIFFERENCE
The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
JOB POST DATE: 6/6/2023