Compliance Lead – Pharmacy

Humana

Compliance Lead ensuring pharmacy policy compliance with regulatory requirements for Medicare operations. Working closely with compliance teams to audit and oversee pharmacy performance.

Posted 6/19/2026full-time🇺🇸 United StatesSenior💰 $115,200 - $158,400 per yearWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

compliance policiesauditingconsultingregulatory guidance interpretationrisk managementclaims operationsPharmacy Benefit Manager (PBM) operationsMedicare Part BMedicare Part Dperformance monitoring

Soft Skills

effective communicationinfluencing decision-makingrelationship managementcollaborationproblem-solvingstrategic developmentoversightanalysisbriefingalignment building

Tools & Technologies

CMSregulatory compliance systemsdata analysis toolsaudit management softwarehealth insurance systems

Certifications & Qualifications

Bachelor's degree

Industry Keywords

health care regulationsgovernment complianceregulatory agenciesmanaged carecontract obligationsregulatory auditssub-regulatory documentsPharmacy complianceMedicare regulationshealth insurance compliance

About the role

Key responsibilities & impact

Ensure compliance with governmental requirements
Work within specific guidelines and procedures; apply advanced technical knowledge to solve complex problems
Receive assignments in the form of objectives and determine approach, resources, schedules and goals
Conduct briefings and area meetings; maintain frequent contact with compliance associates across the department
Support the entire Pharmacy Compliance team in areas including PBM operations, specialty and mail-order dispensing, and key delegated partners
Develop and implement compliance policies and procedures for Medicare Part B and D
Research compliance issues, interpret and recommend changes that ensure compliance with contract obligations and regulator guidance
Assist in the development of strategy and provide ongoing oversight and monitoring of Pharmacy performance including Medicare Parts B and D
Audit and monitor pharmacy and Medicare Part D programs and performance and report to Regulatory Compliance (RC) leadership top risks, remediation plans and other information
Maintain relationships with government agencies and participate in audits with regulators
Collaborate with the team to review and analyze regulatory and sub-regulatory documents and data

Requirements

What you’ll need

Bachelor's degree
Five (5) years of pharmacy experience in claims operations
Four (4) or more years of experience working in a compliance-related, risk management and/or managed care-related field
Four (4) or more years interpreting complex regulatory guidance
Experience in auditing and consulting
Experience working with regulatory agencies, including CMS and/or state departments of health insurance
Knowledgeable in regulations governing health care industries
Knowledge of PBM (Pharmacy Benefit Manager) operations
Demonstrated ability to interpret and translate guidance to various audiences in a highly matrixed setting
Highly effective communicator with the ability to influence decision-making and build alignment across diverse stakeholders.

Benefits

Comp & perks

Medical, dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance and many other opportunities