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Provider Relations-Networking-Contracting WellCare - Provider Administration & Support Careers

Ancillary Vendor Oversight Spec Job

Full Job Title: *Ancillary Vendor Oversight Spec

Job Number: 1701750

Location: Tampa, FL

Date Posted: 4-18-2017

Department: Pharmacy
Reports to: Pharmacy Compliance Audit Mgr.
Location: George Rd.
This position participates in the oversight of WellCare's and/or WellCare's' Delegated pharmacy vendor's corporate ethics and compliance program. Performs job responsibilities primarily through conducting delegation audits, oversight of SLAs and oversight and monitoring to assess compliance with WellCare's contractual and regulatory requirements and collaborates with business owners and/or delegated vendors to drive remediation. Additionally, provides the pharmacy compliance team with audit support and supports ad hoc projects.
Essential Functions:
  • Performs Pre-Delegation and annual delegation audit of pharmacy vendors.
  • Maintains records for all delegated functions of pre-delegation and annual delegation audit reports, CAP's and CAP removal letters
  • Develops Corrective Action Plans as needed and reviews results for completion
  • Monitors CMS guidance, State guidelines and updates audit tools as appropriate. Reviews all new state contracts to ensure audit tools meet state requirements, modifies tool as necessary
  • Reviews and reports monthly scorecards
  • Informs the Delegation Oversight Committee of any new Vendors (or new line of business to an existing vendor) to ensure appropriate Pre-Delegation Audits can be scheduled. Including submission of Pre-Delegation Request Form
  • Assist in the development and maintenance of various Pharmacy policies and procedures effecting Vendor oversight
  • Identify opportunities to improve department results, communications and operating efficiencies
  • Provides support to all Pharmacy Regulatory Audits, including CMS and State Medicaid (Acumen, CMS Financial, RAC Audits and all other Ad Hoc Pharmacy audits.)
  • Maintains a working knowledge of current and proposed pharmacy laws, regulations and guidelines
  • Supports oversight of PDE deletions such as maintenance of Master Deletion list, working with PBMs to ensure requests are deleted
  • A Bachelor's Degree in - Preferred
  • 2 years of experience in Pharmacy - Required
  • Certified Pharmacy Technician - Preferred
  • Experienced in handling service issues for members and providers.
  • Demonstrated strong organizational skills with the ability to prioritize and coordinate multiple tasks
  • Strong oral and written communication skills in order to present to small groups, upper management or vendors who may pose challenging or difficult questions.
  • Ability to exercise good judgment under pressure and to manage a diverse and demanding workload

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Last Updated On: 12/9/2015