Risk & Compliance Manager
Alivia Health
Summary
The Risk & Compliance Manager for Alivia Health's Quality and Compliance Department is responsible for supporting the development, implementation, and ongoing management of the enterprise's compliance and risk management programs. This position identifies, assesses, monitors and helps mitigate regulatory, compliance, operational and business risks across the organization. The Manager partners with business and functional leaders to maintain an effective risk management framework, strengthen compliance controls and promote a culture of accountability, integrity and patient safety. Provides leadership visibility on emerging risks and compliance priorities.
Job description
Responsibilities
- Leads the Compliance & Risk Unit through the supervision of the following roles: Compliance & Regulatory Advisor Privacy Specialist, Q & C Learning Specialist and Compliance Controls & Risk Specialist.
- Oversees leadership of Regulatory Committee
- Monitor regulatory developments and coordinate with Legal, Quality, Pharmacy Operations, HR, Privacy/Security, Finance and other functions to assess organizational impact.
- Manage regulatory examinations, audits, and compliance reviews, serving as the primary liaison with internal and external auditors, regulators, and other stakeholders.
- Oversees contract review and management.
- Develop and maintain the organization's enterprise risk management framework in partnership with the Chief Quality and Compliance Officer and executive leadership.
- Develop and maintain compliance and risk dashboards. Oversee policy governance, compliance controls and risk mitigation tracking.
- Support the Chief Quality & Compliance Officer in maintaining an effective enterprise compliance program consistent with applicable federal and Puerto Rico healthcare requirements and recognized compliance program standards.
- Support the implementation and monitoring of the Organization's Code of Conduct, compliance policies, standards and procedures.
- Responsible for Privacy / HIPAA audit workplan execution, Regulatory and payer inquiries and Contract & marketing compliance
Required
- Bachelor's degree (B.A.) in Business Administration, Law, Risk Management, Pharmacy, Finance, Healthcare Administration or related area from a four-year accredited college or university.
- Five (5) plus years of proven experience leading a compliance & risk unit or internal audit area preferably in healthcare, pharma or other highly regulated industry where the timely identification and establishment of current and emerging risks is required to establish a robust compliance and risk management framework.
- Minimum two (2) years of experience leading resources or project teams.
- Must have one or more of the following compliance certifications: Certified Professional Compliance Officer (CPCO), Certified in Healthcare Privacy Compliance (CHPC); Compliance Certification Board (CCB), SCCE & HCCA Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), Certified Risk Management Assurance (CRMA).
- Experience in managing various internal clients' requests across various business units.
- Excellent oral & written communication skills in English and Spanish, negotiation, and interpersonal abilities.
Requirements
- Bachelor's degree in Business Administration, Law, Risk Management, Pharmacy, Finance, Healthcare Administration or related area
- Five (5) plus years of experience leading a compliance & risk unit or internal audit area
- Minimum two (2) years of experience leading resources or project teams
- One or more compliance certifications: CPCO, CHPC, CHC, CCEP, CIA, or CRMA
- Experience managing internal clients' requests across business units
- Excellent oral & written communication skills in English and Spanish
- Negotiation and interpersonal abilities
Company overview
Alivia Health is a specialized healthcare services company focused on providing comprehensive patient support solutions, particularly in the specialty pharmacy and complex medication management space. The company operates at the intersection of healthcare services and pharmaceutical support, offering critical services that bridge the gap between pharmaceutical manufacturers, healthcare providers, and patients requiring specialized treatments. Alivia Health specializes in managing complex medication therapies, patient assistance programs, and adherence support services for individuals with chronic and rare diseases. Their services typically include benefits verification, prior authorization support, copay assistance programs, medication delivery coordination, and ongoing patient education. The company plays a vital role in ensuring patients can access and afford expensive specialty medications while maintaining proper treatment adherence. By providing these essential support services, Alivia Health helps optimize patient outcomes and reduces barriers to treatment access in the complex healthcare landscape. Their work is particularly important for patients requiring high-cost specialty drugs for conditions such as cancer, autoimmune disorders, and rare genetic diseases.