Lumicera

Lumicera - Lumicera Health Services Powered by Navitus - Innovative Specialty Pharmacy Solutions- Lumicera Health Services is defining the “new norm” in specialty pharmacy to optimize patient well-being through our core principles of transparency and stewardship. Here at Lumicera, our team members work in an environment that celebrates creativity and fosters diversity.

USD $82,587.00 - USD $101,333.00 /Yr.

M-F 8am-5pm, CST

 Due to growth, we are adding a Sr. Manager, Lumicera Compliance to our team!

  

The Sr. Manager, Lumicera Compliance is responsible for coordinating, facilitating and maintaining compliance with all aspects of pharmacy practice for Lumicera specialty pharmacy programs. The Sr. Manager will uphold core compliance elements identified by but not limited to Medicare, Medicaid, Department of Justice, Office of Inspector General and US Sentencing Commission guidelines. This includes development of annual specialty pharmacy compliance program description, work plan and evaluation of program effectiveness; investigation and monitoring of compliance and regulatory violations; and coordination of corrective action plans to ensure compliance with state and federal regulatory agencies and laws. The Sr. Manager assesses potential areas of compliance vulnerability through regular compliance risk assessments, risk identification, mitigation plan coordination providing recommendations to Corporate Compliance and Lumicera leadership. The Sr. Manager regulatory compliance and supports contractually mandated audits.  

 

Is this you? Find out more below!  

How do I make an impact on my team?   

• Facilitates specialty pharmacy and related compliance, OIG risk, audit, and risk strategic initiatives, which support the organizational strategic plan.
• Independently investigate cases of Lumicera non-compliance in accordance with the investigation protocols and procedures, including root cause analyses.
• Oversees, supports and/or provides consultation for established or emerging areas of compliance with specialty pharmacy influence including but not limited to medical billing, PCI-DSS standards, home infusion, Telephone Consumer Protection Act, SOC, HITRUST, and Section 508 accessibility.
• Prepares reports to keep executive leadership and the Lumicera Board of Directors informed on the progress and effectiveness of compliance efforts.
• Ensures compliance presence in departmental interfaces, cross-training, and educational materials for Lumicera.
• Evaluate, review and/or modify policies or operating guidelines to comply with changes to payer requirements or regulations.
• Serve as a confidential point of contact for employees to communicate with management, seek clarification on issues or dilemmas, or report irregularities.
• Participates in Sales activities, including RFP responses for manufacturers and payers and potential client presentations.
• Other duties as assigned

What our team expects from you?  

• A minimum of a Bachelor’s degree is required, preferably in criminal justice, risk management, healthcare, compliance-related field and/or pharmacy.
• Certification in Healthcare Compliance (CHC) preferred or agreement to obtain within 1-2 years of employment.
• A minimum of four (4) years’ experience in pharmacy and/or healthcare compliance, claims investigations and/or auditing is highly desired. Demonstrated experience in a leadership role required. Knowledge of Medicare and Medicaid billing and third-party payer billing regulations and reimbursement is also highly desired.
• Knowledge of specialty pharmacy or healthcare compliance and other state/federal laws that govern specialty pharmacy and related services.  Experience in home infusion, healthcare payment, medical billing, and URAC and/or ACHC accreditation quality program oversight strongly preferred.
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus? 

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account

 

#LI-Remote 

 

We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.