Compliance Lead, Pharmacy

Humana

Humana compliance lead overseeing Pharmacy, Medicare Part B/D, PBM operations, audits, and regulatory guidance. Supporting risk assessments, corrective action plans, and compliance monitoring across U.S.

Posted 8/7/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $115,200 - $158,400 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in compliance with governmental pharmacy operations, including the development and implementation of policies for Medicare Part B and D. Proficient in auditing, risk management, and maintaining relationships with regulatory agencies to ensure adherence to healthcare industry regulations.

Highest-signal resume keywords

Pharmacy Operations ComplianceRegulatory Guidance InterpretationAuditing and Consulting ExperienceHealthcare Compliance CertificationRisk Management Expertise

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Pharmacy Claims OperationsMedicare Part B and D ComplianceRegulatory Document AnalysisData AnalyticsAction Plan Development

Soft Skills

Effective CommunicationStakeholder AlignmentInfluencing DecisionsCollaboration Across Departments

Certifications & Qualifications

Healthcare Compliance Certification (CHC, CCEP)

Industry Keywords

CMSPBM OperationsHealthcare Industry RegulationsManaged CareRisk Assessments

About the role

Key responsibilities & impact

Ensure compliance with governmental requirements for Pharmacy operations
Develop and implement compliance policies and procedures for Medicare Part B and D
Research compliance issues and recommend changes addressing contract obligations and regulator guidance
Interpret regulatory and contract requirements for Humana departments and external partners
Develop strategy and provide ongoing oversight and monitoring of Pharmacy performance
Assist with risk assessments and shape annual audit and monitoring work plans
Complete compliance work for the Medicare Prescription Payment Plan, AIP D-SNP, new implementations, and CMS initiatives
Audit and monitor pharmacy and Medicare Part D programs and report top risks and remediation plans to Regulatory Compliance leadership
Participate in regulator audits and coordinate corrective action plan implementation
Maintain relationships with government agencies and present to outside regulators
Review and analyze regulatory documents and data to demonstrate compliance
Collaborate across operational units and product lines on data analytics and operational improvement
Perform assessments, develop action plans, and advise internal business units
Build relationships with pharmacy business units
Support the Compliance Manager and Senior associates
Conduct briefings and area meetings and collaborate across departments

Requirements

What you’ll need

Bachelor's degree
Five (5) years of pharmacy experience in claims operations
Four (4) or more years of experience in compliance, risk management, and/or managed care
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
Knowledge of healthcare industry regulations
Knowledge of PBM (Pharmacy Benefit Manager) operations
Ability to interpret and translate guidance for various audiences in a highly matrixed setting
Highly effective communication and ability to influence decisions and build stakeholder alignment
PharmD, Juris Doctorate, or master's degree preferred
Certification in healthcare compliance (CHC, CCEP) or similar preferred
Minimum 25 Mbps download and 10 Mbps upload internet service for home or hybrid work
Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information
Ability to work Monday–Friday, 8:30am–5:00pm EST with some flexibility
Up to 5% travel may be required, including occasional travel outside the state of residence

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Remote work arrangement
Optional hybrid home/office arrangement for candidates residing in and around Louisville, KY
Up to 5% travel support for regulatory audits and occasional travel for training or meetings