Legal Compliance Senior Director- Express Scripts Medicaid and Commercial - Hybrid - The Cigna Group
Philadelphia, PA
About the Job
Job Purpose/Description
The Legal Compliance Senior Director- Express Scripts Medicaid and Commercial is responsible for the development, implementation, administration, and oversight of the Pharmaceutical Benefit Manager (PBM) Medicaid and Commercial Compliance Programs. This role reports directly to the Managing Director- Evernorth Benefits Management Compliance, coordinating closely with cross-functional leaders across the organization to identify and mitigate compliance risks.
The Legal Compliance Senior Director- Express Scripts Medicaid and Commercial will serve as the Express Scripts Medicaid Compliance Officer and have direct oversight of the Express Scripts Commercial Compliance Officer. Candidates must be highly organized with the ability to effectively engage with various audiences including internal partners, health plan clients, as well as federal and state regulators.
Key Duties and Responsibilities
+ Maintain open lines of communication with the Chief Compliance Officer and the Managing Director- Evernorth Benefits Management Compliance regarding Compliance Program matters.
+ Lead a team of compliance professionals responsible for assisting in the oversight and administration of Medicaid and Commercial Compliance Program.
+ Partner closely with leaders across the Cigna enterprise including but not limited to Legal, Government Affairs, Enterprise Risk Management, Regulated Markets, and Operations.
+ Maintain established foundation of trust to ensure effective use of reporting mechanisms.
+ Serve as Chair of the Express Scripts Medicaid Compliance Committee.
+ Develop and maintain a comprehensive Compliance work plans in coordination with overall Compliance Department work plans.
+ Maintain the Express Scripts Medicaid and Commercial Compliance Plan Summaries.
+ Coordinate quarterly review of the Medicaid Risk Assessment.
+ Develop and maintain comprehensive monitoring plans.
+ Collaborate with Internal Audit on development of annual audit plans.
+ Respond to compliance concerns posed by regulators, clients and cross-functional partners.
+ Review, understand, and provide guidance, in conjunction with Legal, on applicable regulations and sub-regulatory guidance.
Qualifications
+ Bachelor’s degree in related field or 12+ years overall experience
+ Minimum of 6-10 years of experience in Healthcare Compliance or other relevant experience in regulatory oversight or general compliance matters.
+ Strong background in Medicaid, PBM, or other regulatory compliance programs.
+ Ability to read, analyze, and interpret state regulations, state contracts, and other legal documents.
+ Strong organizational skills with great attention to detail.
+ Team leadership and management experience.
+ Excellent oral and written communication skills.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
The Legal Compliance Senior Director- Express Scripts Medicaid and Commercial is responsible for the development, implementation, administration, and oversight of the Pharmaceutical Benefit Manager (PBM) Medicaid and Commercial Compliance Programs. This role reports directly to the Managing Director- Evernorth Benefits Management Compliance, coordinating closely with cross-functional leaders across the organization to identify and mitigate compliance risks.
The Legal Compliance Senior Director- Express Scripts Medicaid and Commercial will serve as the Express Scripts Medicaid Compliance Officer and have direct oversight of the Express Scripts Commercial Compliance Officer. Candidates must be highly organized with the ability to effectively engage with various audiences including internal partners, health plan clients, as well as federal and state regulators.
Key Duties and Responsibilities
+ Maintain open lines of communication with the Chief Compliance Officer and the Managing Director- Evernorth Benefits Management Compliance regarding Compliance Program matters.
+ Lead a team of compliance professionals responsible for assisting in the oversight and administration of Medicaid and Commercial Compliance Program.
+ Partner closely with leaders across the Cigna enterprise including but not limited to Legal, Government Affairs, Enterprise Risk Management, Regulated Markets, and Operations.
+ Maintain established foundation of trust to ensure effective use of reporting mechanisms.
+ Serve as Chair of the Express Scripts Medicaid Compliance Committee.
+ Develop and maintain a comprehensive Compliance work plans in coordination with overall Compliance Department work plans.
+ Maintain the Express Scripts Medicaid and Commercial Compliance Plan Summaries.
+ Coordinate quarterly review of the Medicaid Risk Assessment.
+ Develop and maintain comprehensive monitoring plans.
+ Collaborate with Internal Audit on development of annual audit plans.
+ Respond to compliance concerns posed by regulators, clients and cross-functional partners.
+ Review, understand, and provide guidance, in conjunction with Legal, on applicable regulations and sub-regulatory guidance.
Qualifications
+ Bachelor’s degree in related field or 12+ years overall experience
+ Minimum of 6-10 years of experience in Healthcare Compliance or other relevant experience in regulatory oversight or general compliance matters.
+ Strong background in Medicaid, PBM, or other regulatory compliance programs.
+ Ability to read, analyze, and interpret state regulations, state contracts, and other legal documents.
+ Strong organizational skills with great attention to detail.
+ Team leadership and management experience.
+ Excellent oral and written communication skills.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
Source : The Cigna Group
