Blue Cross of Idaho
Healthcare
ComplianceSpecialist
Neural analysis suggests this role is
optimal for Mid candidates.
“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.
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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