Director, Ethics & Compliance

Summary

Serving as the Account Compliance Officer, this individual will develop and manage the designated account compliance program and act as client point of contact for compliance issues related to large healthcare and/or pharmacy benefit manager client account(s). This position will have responsibility for the compliance program requirements for the assigned account, including investigation and audit activities. Responsibilities include attending meetings with all levels of client management, reporting status of compliance improvements and investigations, leading compliance projects and programs, leading and/or performing fraud, waste, and abuse investigations, facilitating compliance reviews, and overseeing all account compliance-related activities. In addition, this position will have responsibility to manage the investigative team which includes a manager and investigators. This position will have a responsibility to ensure timely submissions of monthly, quarterly, and annual reports, requests for deconflictions, and referrals of investigation cases to the client. This position is an integral part of the Gainwell pharmacy compliance program and fraud, waste, and abuse program.

The clients that will be supported by this position are highly regulated with comprehensive compliance needs in accordance with state and federal laws and regulations related to healthcare, pharmaceutical, and/or pharmacy benefit manager program requirements.  This position will implement account-specific compliance programs, including development of Corporate Compliance policy addenda to incorporate additional requirements into the Corporate Compliance policies and procedures library, quality improvement projects, risk assessment activities, and staff member training.  This position is required to act as a single point of contact for account compliance program management, and to provide compliance, audit, and regulatory-related subject matter expertise.

Your role in our mission

• Develop and administer account compliance program and risk assessments.
• Develop and update account-specific compliance addenda to corporate policies, procedures, guidance, and training for employees.
• Monitor and provide updates regarding federal and state regulations related to account compliance program, including healthcare, pharmaceutical, and/or pharmacy benefit manager requirements.
• Monitor and assess staff member compliance with policies, procedures, and laws and regulations.
• Develop, oversee, and provide reports regarding account compliance program, including compliance activities, risk assessments, audits, and compliance with regulatory and contractual requirements. 
• Develop preventative and corrective strategies and action plans, as needed, to support the account compliance program, risk assessments, and contractual and regulatory requirements.
• Maintain documentation supporting the Corporate and/or account compliance program, including compliance policies and procedures, manuals, risk management plan, fraud, waste, and abuse plan, etc.
• Communicate with leadership and client regarding account compliance program, activities, risk assessments, audits, etc.
• Lead internal and external compliance-related discussions, presentations, and activities.
• Assist with audits by clients and government agencies.
• Conduct or assist with investigations, as needed.

What we're looking for

• 7+ years of experience in corporate healthcare, pharmaceutical, and/or pharmacy benefit manager compliance and ethics experience is required. State or federal agency experience highly desired.
• Graduate or post-graduate degrees in law and/or experience in the pharmaceutical and compliance industries is required.
• Certification in healthcare compliance or privacy (e.g., CHC, CHPC, CHRC, or CHC-F).
• Experience in pharmaceutical and/or compliance training course design, development, and implementation strongly preferred.
• Experience with healthcare compliance program planning and implementation.
• Experience with risk management analysis and strategies, and ability to link risk management practices to business needs and activities.
• Knowledge of and experience with regulatory compliance requirements related to Medicare and Medicaid reimbursement, fraud, waste, and abuse laws, and HIPAA.
• Skilled in planning, problem solving, analysis, and collaboration.
• Excellent understanding of project management principles.
• Excellent presentation, written and verbal communication skills.
• Strong organizational skills, and ability to handle multiple high-pressure situations simultaneously.
• Proficient with Office 365 (Word, Excel, PowerPoint, Teams, and SharePoint).
• Experience working with large data and detecting noncompliance and fraud, waste, and abuse.
• Experience leading a team, including professional development and performance management for team members is required.
• Experience formally and informally leading and collaborating with all levels of management in compliance-related activities is required.

What you should expect in this role

• This opportunity is 100% remote within the continental United States.
• The Account Compliance Officer may perform additional duties as needed to support Gainwell Corporate Compliance needs or client account needs.  The Account Compliance Officer reports to the Senior Director Compliance & Ethics.

The deadline to submit applications for this posting is July 14, 2025.