Director, Healthcare Compliance - Fraud, Waste, & Abuse

WALGREENS - Deerfield, IL3.6

Full-timeEstimated: $94,000 - $130,000 a year
Job Summary

The Director of Healthcare Compliance works with the Walgreens Compliance leadership team to create the strategic direction for the enterprise-wide healthcare and pharmacy compliance program, focusing on fraud, waste & abuse matters pertaining to Walgreen Co.’s retail and specialty pharmacy businesses and health partnerships. This person is responsible for managing compliance professionals who proactively advise our cross functional partners on executing compliant business initiatives. This person will collaborate with internal and external resources to develop strategies that meet department goals within budget and established timelines. This person will provide broad scale compliance expertise to business leaders and works with leaders in the Walgreens Compliance Department, Legal Department, and other functional areas across Walgreens as needed.

Job Responsibilities
Leads a comprehensive approach to identify fraud, waste and abuse issues in Walgreens pharmacy and healthcare businesses, evaluates and provides assurance to management that objectives are being met. Identifies and implements strategies to resolve problems or barriers that could hinder successful execution of healthcare compliance activities. Key areas of focus are: (1) providing proactive compliance support related to Fraud, Waste & Abuse (e.g., Civil Monetary Penalties, Anti-Kickback Statute, Stark Law, False Claims Act), (2) government billing & reimbursement, and (3) advising on various initiatives related to payor, provider, pharmaceutical company, and patient interactions.
Engages business segment leaders in the pharmacy and healthcare compliance process to ensure strategic objectives are well understood in order to deliver anticipated results and manages strategic initiatives.Provides day-to-day compliance expertise on pharmacy business matters and remains abreast of activities implicating healthcare compliance.Identifies potential areas of healthcare compliance vulnerability and risk and provides guidance on how to avoid or mitigate such risk going forward.
Establishes and maintains relationships and networks with departments that interact with the Compliance Department.Works collaboratively with members of the Compliance Department, the Legal Department, and other functional areas within the Company to ensure that appropriate actions are taken to implement strategic and operational initiatives in a compliant manner.
Evaluates identified compliance issues and creates strategies to ensure healthcare compliance issues/concerns within the organization are appropriately resolved.Evaluates audits, monitoring, and investigations data and identifies preventative controls to mitigate risk.Regularly presents key compliance initiatives to Walgreens senior leadership and other business leaders on a routine basis.
Develops architecture and framework with compliance team members and other functional leaders and subject matter experts to enhance the compliance program through proactive identification of risk and provision of compliance guidance, and the development and governance of policies, procedures, training, monitoring, and system control mechanisms across Walgreens.

Walgreens, one of the nation's largest drugstore chains, is included in the Retail Pharmacy USA Division of Walgreens Boots Alliance, Inc., the first global pharmacy-led, health and wellbeing enterprise. More than 10 million customers interact with Walgreens each day in communities across America, using the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice. Walgreens operates 8,175 drugstores with a presence in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. Walgreens omnichannel business includes Approximately 400 Walgreens stores offer Healthcare Clinic or other provider retail clinic services.

As the neighborhood drugstore and retailer, our goal is to make health and happiness simpler, easier and within reach. And we remain a trusted wellness provider offering convenient access to important health services, such as immunizations and an array of pharmacy services that can help patients improve their health. To our team members, Walgreens represents a unique opportunity to excel in their careers in a welcoming and inclusive environment. We offer the chance to work in a truly supportive environment, and be a part of a progressive organization dedicated to the well-being of our customers, team members and the communities we all call home.

Basic Qualifications
Bachelor’s degree and at least six (6) years of experience in a pharmacy and/or health care compliance role or role with similar experience.
Experience developing and implementing compliance strategies to support business and operational priorities within a matrixed global organization.
Experience evaluating recommendations from cross functional team members in order to implement the elements of an effective ethics and compliance program across multiple business units.
Experience evaluating information to determine compliance with U.S. Federal health care program requirements, and relevant laws and regulations for pharmacy and healthcare business.
Experience establishing and maintaining long-term relationships with management and individuals at all other levels of the organization through respectful and professional collaboration.
Experience using communication skills / executive presence to support the evolution of strategies and tactics at the leadership level.
Experience diagnosing risks and compliance issues and presenting solutions and alternatives with other senior leaders.
Experience using time management skills to balance strategic work with team management to ensure all employee matters are managed to support employee professional development and are within budget and aligned to priorities of the business.
Experience in either direct and/or indirect management of team members to facilitate cross-functional projects, including assisting in the development, training and assignment of work/projects to other team members.
Willing to travel up to 10% of the time for business purposes (within state and out of state).

Preferred Qualifications
Bachelor’s degree and at least ten (10) years of experience in a pharmacy and/or healthcare compliance role or a role with similar experiences, such as internal audit.
Juris Doctorate and at least five (5) years of post-bar experience in a law firm and/or corporate setting OR a a Bachelors degree and at least 10 years of experience in a health care compliance role with similar experiences.
Experience working in a complex, matrixed organization.
At least five (5) years of relevant legal or compliance experience OR experience with similar roles (e.g., internal audit).
At least five (5) years of overall experience working in a corporate compliance department or equivalent.