Director, Regulatory Compliance, Quality, and Performance Excellence

San Mateo, CA /
Legal – General /
Full-time
The Company:

WithMe Health provides a medication guidance solution that replaces legacy Pharmacy Benefit Managers (PBMs) by using modern technology and rich datasets to consistently apply proven science and create individualized experiences for employees and their families. WithMe Health’s solution is unlike any other medication guidance solution in the market today: it is proactive, adaptive, convenient, and engaging. And WithMe Health’s innovative, outcomes-oriented business model aligns interests across the pharmaceutical value chain, optimizing health outcomes while substantially reducing costs for employers.

The company was formed in 2018 to address the growing challenges and unmet needs that employers and employees face with legacy PBMs: misaligned business models, frustrating interactions, unknown outcomes, high costs, and a lack of real transparency. Having recently closed a $20 million round of financing from Oak HC/FT, WithMe Health is poised for significant growth while disrupting the $453 billion PBM industry and is looking to build out its team to help achieve this growth.

The Role:

WithMe Health is looking for a Director of Regulatory Compliance, Quality, and Performance Excellence to be responsible for planning, leading and executing upon strategies and tactics to drive performance excellence in concert with WithMe’s Compliance and Quality Programs.

Responsibilities:

    • Serves as WithMe’s Quality Improvement and Compliance Officer ensuring adherence to regulations governing WithMe services
    • Oversees and assists in the writing and development of policies and procedures necessary to meet all applicable regulations and accreditation standards (e.g., URAC)
    • Works and collaborates with a multidisciplinary team of quality assurance/quality improvement staff from various WithMe departments
    • Provides trend analysis and corrective measures as needed for in-process monitoring, deviation reports, investigation reports and corrective action plans (CAPs)
    • Oversees, gathers, facilitates, and disseminates timely reports and information to appropriate individuals or external entities necessary for WithMe to meet all regulatory and accreditation requirements
    • Oversees the administration, coordination and evaluation of quality assurance and training, including policy and procedure development, training assessments and quality adherence auditing
    • Directs the execution of performance improvement projects, including process mapping and process design and metrics to be tracked and routinely reported
    • Creates and maintains dashboards, communications, and strategies to improve WithMe’s services 
    • Research and develop best practices, policies, procedures, and goals in compliance with internal and external guidelines 
    • Oversee data analysis and gathering processes and programs to establish costs and benefits of process effectiveness and efficiency
    • Review and implement new technological tools and processes 
    • Establish strong collaborative relationships with all functional units and their leaders
    • Identifies and manages key projects that drive continuous improvement and efficiency in WithMe’s operations
    • Develops, implements and conducts periodic internal reviews of all functional areas for compliance and serve as a key resource regarding quality and compliance issues
    • Prepare and conduct periodic Quality Management Reviews
    • Manages client audits and questionnaires, including preparation and process to ensure WithMe’s qualification as a service provider
    • Develops and crafts responses for client questionnaires related to quality and compliance. This includes responses for Request for Information (RFIs) or Request for Proposals (RFPs)
    • All other duties as assigned

Qualifications

    • Bachelor's degree in a related healthcare field or related-clinical degree.
    • Minimum of 5 years’ experience in quality management, leading quality improvement and compliance initiatives in healthcare operations
    • Working knowledge and familiarity of compliance, quality management, and URAC accreditation requirements applicable to Pharmacy Benefits Managers (or Health Plan), is preferred)
    • Minimum three years of experience at a Manager level or higher is required
    • Good oral and written communications and ability to use various software (e.g., MS Office Suite/SharePoint, Google docs, Miro, and Asana)
    • Must have the ability to motivate, influence and inspire others
    • Strong understanding of healthcare privacy and other relevant healthcare regulations
    • Strong understanding of Quality Management Systems
    • Six Sigma or other forms of lean process experience preferred
There are many reasons to come work for us but we’ll just list a few: 
Highly competitive pay 
100% employer-paid health coverage for employee
401(k) plan eligible day 1
Medical memberships 
Paid life insurance 
8 weeks’ parental leave for primary caregiver 
Flex spending 
Results-only work environment 
Generous vacation policy 

What does all that mean? It means we want you to be successful and fulfilled; to be happy and to grow. We are trying hard to be one of the best places to work and we pride ourselves on doing more for our people. We have some amazing people here and are excited to talk to you more about joining us. Are you ready? 

WithMe is committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans in our job application procedures