Contract Compliance Manager

Magellan Health Services Richmond , VA 23234

Posted 2 months ago

Overall oversight and management of client contract compliance, performance guarantee measurement and reporting.

  • Develops strong internal relationships and contacts within the company that are supportive of the achievement of customer service requirements including attainment of performance guarantees and minimization of performance penalty expense.

  • Ensures Service Level Agreement performance.

  • Supports the account management team to ensure performance standards are measurable and realistic to achieve and/or exceed to avoid penalties.

  • Partners with Operations and Network on performance monitoring. Manages methodology, reporting and communications.

  • Ensures all customer and account-facing services are provided in a consistent and timely fashion.

  • Maintains reporting calendar to ensure timely submission.

  • Analyzes data and reporting and supports executive summary development.

  • Resolves or appropriately escalates customer service issues in conjunction with operations (claims, service, and systems).

  • Builds relationships and alliances with matrix partners.

  • Understands the customer's structure and demonstrates the ability to apply this knowledge in business and retention planning for the client.

  • Coordinates with Compliance and Legal departments on knowing and understanding regulations and the implication to customer impact and ensuring contract compliance

  • Maintains a client audit schedule to ensure a proactive approach in supporting critical client compliance.

  • Coordinates all customer audit preparation and execution.

  • Supports in the development and maintenance of a strategic business plan that fully reflects the customer's business objectives and how the company's solutions align to those objectives and specifically guides our operational, financial, network, clinical and relationship initiatives.

  • Proactively communicates to internal and external contacts.

  • Demonstrates contract understanding and detailed knowledge of business requirements.

  • Supports the account management team in the definition of customer reports and ensures coordination with the client.

  • Prepares and supports presentations of customer reports with meaningful analytics, trending and recommendations for program improvement based on findings.

  • Develops strong relationships which penetrate the customer at various levels involving other internal company staff to maintain multiple connections and strengthen the overall relationship.

  • Contributes to overall account satisfaction within the company as well as satisfaction with all specific areas particularly account management.

  • Demonstrates knowledge of the company's products and services, and how multiple products and services are interdependent within the customer contract deliverables and clinical outcomes. Maintains in-depth knowledge of client.

Other Job Requirements

Responsibilities

  • Requires Bachelor's degree plus five years of Pharmacy Benefit Management (PBM) experience.

  • May consider an additional four years of related experience in lieu of degree.

  • Prefer experience in account management, business analysis or call center operations.

General Job Information

Work Experience

PBM (Pharmacy Benefit Management)

Education

A Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)

License and Certifications

  • Required

License and Certifications

  • Preferred

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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Contract Compliance Manager

Magellan Health Services