The Compliance Specialist II is responsible for supporting the organization’s compliance program with a primary focus on specialty pharmacy and patient care regulatory oversight. This role partners with business owners to help ensure adherence to federal and state regulatory requirements, payer contractual obligations, and government required accreditation standards specific to specialty pharmacy services. The Specialist performs regulatory analysis, auditing, monitoring, risk assessments, issue resolution, policy/procedure assistance and compliance education while serving as a subject matter expert for specialty pharmacy-related compliance requirements.

Experience: 4+ years in payer compliance, pharmacy, or clinical operations.

Education: Bachelor’s degree or equivalent work experience.

• Integrated health plan experience

• Experience with Medicare Part D or pharmacy accreditation preferred.

• Leadership experience preferred.
• Certification in healthcare compliance or Pharmacy Tech certification preferred.
• Licensure as a RN preferred.

• Regulatory analysis
• Audit and risk assessment
• Communication and training
• Analytical problem solving

• Analyze and interpret federal and state pharmacy regulations including but not limited to: CMS, FDA, State Boards of Pharmacy, and DOI.
• Provide consultative assistance related to implementation for operations.
• Maintain awareness of REMS programs and specialty drug compliance requirements.

• Coordinate compliance risk assessments for specialty pharmacy functions.
• Support monitoring and auditing work plans.
• Partner with business owners to ensure regulatory requirements are integrated into policies and procedures.
• Coordinate compliance efforts with Pharmacist in Charge.

• Conduct, coordinate and/or review audits of dispensing, documentation, and patient outreach.
• Analyze findings and recommend corrective actions.
• Support external audits including CMS and accreditation reviews.

• Investigate compliance issues and perform risk ranking.
• Develop corrective action plans with stakeholders.
• Track remediation efforts through completion.

• Provide information to Corporate Compliance on training including FWA and HIPAA.
• Distribute regulatory updates and communications.
• Work with Pharmacist in Charge to develop training as needed.

• Advise and/or consult with pharmacy operations and leadership.
• Collaborate with PBMs, manufacturers, and vendors.
• Promote compliance best practices.

As of the date of this posting, a good faith estimate of the current pay range is $78,064 to $117,095. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.

We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.