Blue Cross of Idaho

Healthcare

ComplianceSpecialist

$78–78k United States FULL TIME
Market Sentiment
HIGH DEMAND

Neural analysis suggests this role is
optimal for Mid candidates.

The Brief

“Compliance Specialist at Blue Cross of Idaho. Skills: Specialty pharmacy compliance, Regulatory oversight, Risk management. Analyze federal and state pharmacy regulations. Interpret CMS regulations”

Industry & Context.

Healthcare
Problems you'll solve

Analytical problem solving

What They're Looking For.

Must Have

4+ years payer compliance, 4+ years pharmacy operations, 4+ years clinical operations, Bachelor's degree or equivalent work experience

Nice to Have

Medicare Part D experience, Pharmacy accreditation experience, Leadership experience, Certification in healthcare compliance, Pharmacy Tech certification, RN licensure

What You'll Do.

Analyze federal and state pharmacy regulations

Interpret CMS regulations

Interpret FDA regulations

Interpret State Boards of Pharmacy regulations

Interpret DOI regulations

Provide consultative assistance for implementation

Maintain awareness of REMS programs

Maintain awareness of specialty drug compliance

Coordinate compliance risk assessments

Support monitoring work plans

Support auditing work plans

Integrate regulatory requirements into policies

Integrate regulatory requirements into procedures

Coordinate compliance efforts with Pharmacist in Charge

Conduct audits of dispensing

Conduct audits of documentation

Conduct audits of patient outreach

Coordinate audits of dispensing

Coordinate audits of documentation

Coordinate audits of patient outreach

Review audits of dispensing

Review audits of documentation

Review audits of patient outreach

Analyze audit findings

Recommend corrective actions

Support external audits

Support accreditation reviews

Investigate compliance issues

Develop corrective action plans

Track remediation efforts

How You'll Work.

Team & Collaboration

Partner with business owners; Collaborate with PBMs; Collaborate with manufacturers; Collaborate with vendors; Advise pharmacy operations; Consult with pharmacy operations; Advise pharmacy leadership; Consult with pharmacy leadership

Communication Scope

Regulatory updates; Regulatory communications

Full Job Description

The Compliance Specialist II is responsible for supporting the organization’s compliance program with a primary focus on specialty pharmacy and patient care regulatory oversight. This role partners with business owners to help ensure adherence to federal and state regulatory requirements, payer contractual obligations, and government required accreditation standards specific to specialty pharmacy services. The Specialist performs regulatory analysis, auditing, monitoring, risk assessments, issue resolution, policy/procedure assistance and compliance education while serving as a subject matter expert for specialty pharmacy-related compliance requirements. # We are looking for a Compliance Specialist with: Experience: 4+ years in payer compliance, pharmacy, or clinical operations. Education: Bachelor’s degree or equivalent work experience. ## Preferred Experience * Experience with Medicare Part D or pharmacy accreditation preferred. * Leadership experience preferred. * Certification in healthcare compliance or Pharmacy Tech certification preferred. * Licensure as a RN preferred. # ## Core Competencies * Regulatory analysis * Audit and risk assessment * Communication and training * Analytical problem solving # # **Key Responsibilities** ## ## Regulatory Oversight & Analysis * Analyze and interpret federal and state pharmacy regulations including but not limited to: CMS, FDA, State Boards of Pharmacy, and DOI. * Provide consultative assistance related to implementation for operations. * Maintain awareness of REMS programs and specialty drug compliance requirements. ## ## Compliance Program Execution * Coordinate compliance risk assessments for specialty pharmacy functions. * Support monitoring and auditing work plans. * Partner with business owners to ensure regulatory requirements are integrated into policies and procedures. * Coordinate compliance efforts with Pharmacist in Charge. ## ## Auditing & Monitoring * Conduct, coordinate and/or review audits of dispensing, d

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