Pbm Manager Jobs in Michigan (NOW HIRING)

The Director of Audit is responsible for overseeing the organization's client and pharmaceutical rebate audit function and ensuring the effectiveness of financial, operational, and contractual compliance controls across the enterprise. This role also supports organizational SOC audits. This role leads the planning and execution of audit programs, identifies risk exposures, and provides actionable recommendations to enhance operational execution, governance, efficiency, and compliance. The Director works closely with executive leadership to promote a strong internal control culture and continuous improvement mindset. In addition, this role supports participants in Synergie pharma audits.

Audit Execution. 35%

• Lead and oversee pharma and client audits for Synergie.
• Support SOC audit evidence gathering for annual audit.
• Ensure audit work adheres to contractual standards and organizational policies.
• Evaluate the efficiency and effectiveness of internal controls, processes, and risk management frameworks.
• Coordinate with external auditors and participants to ensure alignment and minimize redundancy.
• Communicate with participants during pharma rebate audits and obtain evidence requested.

Risk Management and Compliance. 35%

• Collaborate with Finance, Legal, and IT to strengthen controls around invoicing.
• Monitor corrective action plans, ensuring timely resolution of audit findings. Advise on new business processes, system implementations, and policy changes from a risk perspective.
• Assist in development and manage invoicing and audit policies and procedure.

Leadership and Strategy. 30%

• Develop and execute the annual risk-based audit plan aligned with organizational strategy and regulatory requirements.
• Provide strategic direction and thought leadership for audit, risk management, and internal control programs.
• Partner with internal leaders to identify and mitigate emerging risks within invoicing and data governance of invoicing information.
• Present findings, insights, and progress updates to Invoicing & Audit management.

Requirements:

• Bachelor's degree in business, healthcare, or other related field; Master's degree preferred.
• 8+ years of work experience in a health care auditing role, with expertise in health plans, health systems, pharmacy, and managed care or specialty pharmacy. Must include at least 3 years of experience in medical and/or pharmacy drug management at a health plan or PBM.
• Strong experience managing external audit vendors during audits
• Strong understanding of audit practices
• Experience designing and executing audit programs.
• Strong data management and analytics skills with the ability to manage large data effectively.
• Strong knowledge of medical and pharmacy rebates, value-based contracts, and invoicing processes.
• Demonstrated ability to lead cross-functional teams, drive results in a fast-paced environment, and manage client support while ensuring alignment with Synergie's objectives.
• Ability to develop relationships and influence with internal and external stakeholders
• Excellent leadership, communication and critical thinking skills and ability to anticipate issues and develop solutions.
• Must be eligible to work in the United States without need for work visa or residency sponsorship.

The compensation for this role is budgeted between $150,000 and $200,000.

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