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Managed Care Compliance - Manager

Company: PwC
Location: New York
Posted on: May 13, 2024

Job Description:

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:
      • Assisting on business development opportunities and/or engagements from pre-sale and initial scoping through final delivery and signoff;
      • Utilizing consistent creative problem-solving abilities and consultancy mindsets while working on, as well as researching, problems and/or issues and developing effective solutions for, clients' healthcare compliance activities;
      • Conducting internal audits emphasizing clinical, legal, auditing or other compliance areas;
      • Identifying and addressing client needs, building solid relationships with clients, developing an awareness of firm services, approaching client in an organized and knowledgeable manner, delivering clear requests for information, and demonstrating flexibility in prioritizing and completing tasks;
      • Demonstrating knowledge of tech enabled solutions (visualization, analytics, RPA) and approaches;
      • Maintaining relationships and building credibility with companies and professional affiliations, organizations or networks within healthcare, ethics and compliance;
      • Conducting analyses that leverage creative and critical thinking and problem solving, as well as utilize consensus building skills to derive solutions through, utilizing information systems, databases, Excel and Microsoft Word,
      • Developing strategy as well as writing, communicating, facilitating, and presenting cogently to and/or for all levels of industry audiences, clients and internal staff and management;
      • Budgeting and forecasting on large engagements;
      • Leading teams, supervising teams to create an atmosphere of trust, seeking diverse views to encourage improvement and innovation, participating in various staff recruitment and retention activities, and coaching staff including providing timely meaningful written and verbal feedback; and,
      • Demonstrating flexibility and desire to travel, as client assignments require.
        Learn more about how we work: https://pwc.to/how-we-work

        PwC does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: https://pwc.to/H-1B-Lottery-Policy.

        All qualified applicants will receive consideration for employment at PwC without regard to race; creed; color; religion; national origin; sex; age; disability; sexual orientation; gender identity or expression; genetic predisposition or carrier status; veteran, marital, or citizenship status; or any other status protected by law. PwC is proud to be an affirmative action and equal opportunity employer.

        For positions based in San Francisco, consideration of qualified candidates with arrest and conviction records will be in a manner consistent with the San Francisco Fair Chance Ordinance.

        Applications will be accepted until the position is filled or the posting is removed, unless otherwise set forth on the following webpage. Please visit this link for information about anticipated application deadlines: https://pwc.to/us-application-deadlines

        For positions in California, Colorado, Hawaii, Nevada, New York State, or Washington State, or for opportunities that will report to a supervisor, office or other work site in New York State, please visit the following link for pay range information: https://pwc.to/payrange-v1-advisorymanager

        #LI-Remote

Keywords: PwC, New York , Managed Care Compliance - Manager, Executive , New York, New York

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