Compliance Specialist

Location: Hybrid (Local to NYC area) or Remote (For Non-Local)

Position Summary:

The Compliance Specialist will play a critical role in supporting Capital Rx's Compliance department's efforts to ensure adherence to applicable laws, regulations, and internal policies. This role involves assisting with a broad range of compliance activities, which may include reporting, training, communication, auditing, internal investigations, and/or corrective and preventive actions (CAPAs). The Compliance Specialist may work closely with their Compliance Manager and other stakeholders to support the development and execution of FDR oversight, RFP and RFI responses, pre-delegation audits and contribute to the creation and delivery of compliance materials. Additionally, the Compliance Specialist may own the submission of several regulatory reports. This position requires strong organizational skills, attention to detail, and the ability to manage multiple priorities while maintaining a commitment to high-quality work.

Position Responsibilities:

• Assist with compliance needs across the department, including reporting, training, communication, auditing, internal investigations, and corrective and preventive actions (CAPAs).
• Investigate compliance issues under the guidance of the Compliance Manager, including supporting corrective action plan creation, oversight, and reporting.
• Monitor and audit Vendor Management compliance, including oversight of First Tier, Downstream, and Related Entities (FDRs).
• Collaborate with operational business areas to ensure compliance with applicable requirements, including federal and state laws, regulations, guidance, orders, bulletins, and other compliance-related items.
• Partner with business areas to support the creation, maintenance, and improvement of effective, accurate, and efficient business processes.
• Assist in preparing and delivering internal and external compliance communications and training materials.
• Maintain awareness and understanding of the organization's lines of business to support compliance in ongoing operations.
• Build and maintain strong relationships with internal and external stakeholders by ensuring excellence in service delivery and oversight.
• Perform other compliance duties as assigned by the Compliance Manager, including support for licensing, process improvements, product development, and other compliance activities.
• Responsible for the adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Minimum Qualifications:

• Bachelor's degree in business, healthcare, or a related field preferred; equivalent work experience may be considered in lieu of a degree.
• 2+ years of experience in PBM, health plan, or related healthcare industry roles.
• Familiarity with audit requirements and industry standards, with demonstrated ability to support regulatory and compliance audits.
• Experience assisting with risk identification, resolution communication, tracking, and trending.
• Strong written and verbal communication skills with the ability to create compliance-related documentation, training materials, and reports.
• Organized and detail-oriented, with the ability to manage multiple priorities and deadlines effectively.
• Flexible and innovative mindset, with the ability to adapt to changing business needs.
• Commitment to producing high-quality work products.

Preferred Qualifications:

• Advanced degree in business, healthcare, compliance, or a related field.
• Experience working in a compliance role within a PBM, health plan, or healthcare-related organization.
• Familiarity with federal and state healthcare regulations, including CMS guidelines.
• Proficiency in using compliance management or audit tools and software.
• Demonstrated ability to develop and deliver compliance training programs.
• Experience collaborating with cross-functional teams in a fast-paced environment.
• Strong analytical and problem-solving skills.
• Knowledge of vendor management practices, including oversight of First Tier, Downstream, and Related Entities (FDRs).

Base Salary: $60,000 - $75,000

Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.

Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation's electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp, Capital Rx is executing its mission through the deployment of JUDI, the company's cloud-native enterprise health platform, and a Single-Ledger Model, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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