Vice President, PBM Compliance, Regulatory Operations
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Job Description
Vice President of Compliance overseeing PBM regulatory and privacy operations at Liviniti. Building a compliance program and ensuring adherence to regulations while leading a team.
Responsibilities:
- Build and Implement the Compliance Function
- Own and maintain a state-by-state regulatory inventory and monitoring process
- Partner with operations and technology to implement requirements in areas such as claims adjudication, MAC pricing, pharmacy network standards, and appeals processes
- Build and maintain a continuous state of market conduct exam readiness
- Conduct internal readiness reviews and mock exams
- Design and implement system-based compliance controls and automated edits within PBM platforms
- Oversee PBM responsibilities under the Consolidated Appropriations Act (CAA)
- Provide executive leadership for the organization’s HIPAA Privacy, Security, and Breach Notification compliance programs
- Serve as executive lead for HIPAA-related incidents, overseeing intake, investigation, risk assessment, and breach determination
- Operate as a hands-on leader, directly owning key deliverables in early stages
- Build and scale the compliance team over time
- Provide regular reporting and insight to executive leadership
Requirements:
- Bachelor's degree (B.A.) in Law, Healthcare Administration, Business Administration, Public Health, Pharmacy, or a related field, or 2+ years of related experience and/or training; or equivalent combination of education and experience
- High degree of professional ethics and integrity
- Sound judgment and ability to analyze situations and information
- Juris Doctor (JD) or equivalent legal background strongly preferred
- 10+ years of experience in healthcare compliance, PBM, health plan, or similar regulated environment
- Demonstrated experience implementing regulatory requirements into operations, systems, or workflows
- Strong knowledge of state PBM laws or comparable multi-state regulatory frameworks
- Experience supporting market conduct exams, audits, or regulatory reviews
- Proven ability to work cross-functionally with technology, operations, legal, and finance teams
Benefits:
- Medical, Dental, Vision insurance
- Disability and Life insurance
- Employee Assistance Program
- Remote work options
- Generous Paid-Time Off
- Annual Reviews and Development Plans
- Retirement Plan with company match immediately 100% vested
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