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Managed Care Compliance - Manager - New York New York
Company: PwC Location: New York, New York
Posted On: 05/17/2024
Specialty/Competency: Business Controls Industry/Sector: Pharma and Life Sciences Time Type: Full time Travel Requirements: Up to 60% A career in our Healthcare Compliance practice, within Risk and Compliance services, will provide you the opportunity to work with a team that provides clients with extensive risk and controls technical knowledge and sector specific experience. You'll have the opportunity to develop a holistic approach to risk that protects businesses, facilitates strategic decision making and enhances efficiency by assisting management in the assessment of project risks and controls. Our team helps clients navigate and evaluate healthcare risks by managing and enhancing their governance, risk, and compliance activities. We help to design, develop, and enhance their healthcare compliance programme by aligning their business strategies with their current programmes and optimising internal controls. To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future. As a Manager, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to: - Develop new skills outside of comfort zone.
- Act to resolve issues which prevent the team working effectively.
- Coach others, recognise their strengths, and encourage them to take ownership of their personal development.
- Analyse complex ideas or proposals and build a range of meaningful recommendations.
- Use multiple sources of information including broader stakeholder views to develop solutions and recommendations.
- Address sub-standard work or work that does not meet firm's/client's expectations.
- Use data and insights to inform conclusions and support decision-making.
- Develop a point of view on key global trends, and how they impact clients.
- Manage a variety of viewpoints to build consensus and create positive outcomes for all parties.
- Simplify complex messages, highlighting and summarising key points.
- Uphold the firm's code of ethics and business conduct.
Healthcare Compliance professionals help clients meet regulatory requirements and respond to regulatory actions through assessments, design frameworks and controls, embed tech enabled solutions and implementation. They work with clients to understand their regulatory environment, apply regulatory standards, prepare them for regulatory exams, develop responses to regulators to help clients remain compliant with regulations. Job Requirements and Preferences : Basic Qualifications : Minimum Degree Required : Bachelor Degree Minimum Years of Experience : 5 year(s) of Healthcare Compliance experience, such as consulting, risk management or operational roles. Preferred Qualifications : Degree Preferred : Master of Business Administration Certification(s) Preferred : Certified in Healthcare Compliance (CHC), Certified Health Privacy Compliance (CHPC), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), Certified Public Accountant (CPA) Preferred Knowledge/Skills : Demonstrates extensive knowledge of and/ or proven record of success in roles involving healthcare compliance, preferably for a professional services firm, including in the following areas: - Leading auditing and monitoring projects to address specific healthcare compliance risks;
- Following up on corrective actions in response to identified issues and audits;
- Developing healthcare compliance policies and procedures, emphasizing prior success in roles leveraging compliance hotline protocols and compliance investigation process and procedures;
- Exhibiting familiarity with healthcare compliance regulatory agencies and a general understanding of healthcare laws and regulations (e.g., HIPAA, CMS, Medicare, Medicaid, Affordable Care Act, Anti-Kickback, Fraud and Abuse laws, False Claims Act, Accreditation, Research and Academic Medical Center experiences); and,
- Managing and evaluating professional staff.
Demonstrates extensive level of abilities and/or proven record of success in managing client engagements related to directing and implementing ethics and compliance programs within the healthcare industries, preferably for a professional services firm, including the following: |
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