PBM Compliance Mgr (contract)

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Job ID: JP00044079

Anticipated Start Date: 11/27/2025

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for contract workers ( via BCforward) who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Responsible for coordinating NextRx compliance activities and initiatives across the PBM and the enterprise by maintaining department approved regulatory and legislative compliance plan and implementing effective internal controls.

Primary job function will be reviewing delegate's documentation against accreditation standards, monitoring delegate reports against requirements and accreditation standards and potentially auditing delegate on a routine basis to ensure delegate is meeting delegation requirements as well as accreditation standards.

MUST BE LOCATED WITHIN 1 HOUR DRIVE OF THESE LOCATIONS: Woodland Hills CA, Denver CO, Colorado Springs CO, Des Moines IA, Gilbert MN, Wallingford CT, Midland GA, Indianapolis IN, Louisville KY, Latham NY, Middletown, NY, Las Vegas NV, or Richmond VA.

Primary duties may include, but are not limited to:

• Identifies, monitors, revises and tracks business unit processes and implementing procedures to ensure compliance with all related measures.
• Identifies potential risks associated with PBM activities and ensures procedures are in place to minimize risks.
• Partners with business units to ensure compliance with all statutory and regulatory requirements.
• Participates as compliance subject matter expert on all mandated projects.
• Achieves business operational compliance with all related measures relative to HIPAA and SOX and Privacy and Security Office initiatives.
• Conducts, directs, leads and facilitates all activities related to Internal and External (Regulatory and Client) audits and responds to findings.
• Performs high level regulatory research, develops strategic plans and pro-actively anticipates business needs and requirements.
• Develops and implements training and communication plans.
• Manages and leads scheduled and ad-hoc compliance projects.
Provides and delivers compliance consultation services to the business unit.

Requirements :

• Requires BA/BS.
• 6-10 years experience; or any combination of education and experience, which would provide an equivalent background.
• MS/MBA or field related professional designation preferred.
• Ability to travel required.
• Ideal candidate would have accreditation experience in either NCQA Utilization Management or Health Plan and/or URAC HUM or PBM accreditation as well as delegation oversight experience in the pharmacy realm.

Job Type: Contract with potential for hire.

Additional Details:

• Standard M-F workday with start time no earlier than 8AM Eastern and no later than 9:30AM Eastern with appropriate adjustments for alternate time zones.
• Hybrid 1x week in any Pulsepoint location.
• Pulsepoint Locations: Woodland Hills CA, Denver CO, Colorado Springs CO, Des Moines IA, Gilbert MN, Wallingford CT, Midland GA, Indianapolis IN, Louisville KY, Latham NY, Middletown, NY, Las Vegas NV, or Richmond VA.
• Potential to convert to FTE around 6 months.

About BC forward :

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BC forward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BC forward to become a market leader and best in class place to work.

BC forward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BC forward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BC forward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.