SCAN · 2 weeks ago
Manager, Pharmacy Compliance
Long Beach, CA
Full-time
Hybrid
Mid, Senior Level
$148K/yr - $214K/yr
5+ years expSCAN Group is a not-for-profit organization dedicated to tackling pressing issues facing older adults in the United States. The Manager of Pharmacy Compliance will lead the design and execution of the Part D program while ensuring compliance with CMS regulations and overseeing the pharmacy benefit manager's operations.
Elder CareHealth CareHome Health CareMedical
Responsibilities
Lead and support CMS Part C and D Program Audits, Data Validation Audits, manage Universe Files, oversee HPMS reporting (CDR, IDUC, Appeals, Grievances), and monitor audit preparedness through mock audits and post-submission review
Supervise the Pharmacy Experience & Access team to oversee and optimize PBM delegated programs (concurrent DUR, retroDUR, FWA, Patient Safety Analysis, Opioids) for compliance and effectiveness
Ensure CDAG operations (coverage determinations, appeals, grievances) are timely, compliant, and effective, preventing ICARs, CMPs, and data accuracy issues
Implement process enhancements that strengthen compliance, efficiency, and member experience through routine tracking and trending
Maintain up-to-date clinical policies and SOPs, ensuring internal adherence across clinical operations
Serve as subject matter expert for Part D coverage determinations, redeterminations, grievances, and Part C organization determinations
Stay current with Medicare Part D regulations by attending CMS calls and applying released guidance to maintain compliance
Oversee PBM operations, collaborating on process improvements and CMS updates to support quality performance and enhance member experience
Provide supervision, development, and coaching to pharmacists, technicians, and support staff, fostering a culture of process improvement, operational excellence, and compliance
Act as Residency/APPE Director, setting expectations, appraising performance, and supporting student/resident pharmacists and their preceptors
Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
Actively support the achievement of SCAN’s Vision and Goals
Other duties as assigned
Qualification
Required
Bachelor's Degree required
PHARMD or equivalent
Required Certifications or Licenses: Pharmacists (PHs)
Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice experience
Demonstrated knowledge of and experience monitoring Medicare Part D regulations, required
5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred
1-2 Years Leadership/management Experience Strongly Preferred
Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership
Previous experience in precepting and mentoring pharmacy students and residents is desirable
Leadership - Lead and inspire teams to achieve performance goals, offering guidance and support
Problem Solving - Good problem-solving skills
Communication - Good communication and interpersonal skills
Strong analytical, problem-solving, and decision-making abilities - Ability to think strategically while executing tactically - Detail-oriented and highly adaptable to a fast-paced, evolving environment - Demonstrated ability to manage multiple priorities simultaneously
Proven leadership, supervisory, and accountability skills - Strong organizational, time management, and project management capabilities - Self-starter with a resourceful and innovative mindset - Effective across cross-functional teams and collaborative environments
Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions
Communication & Professionalism - Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions
Preferred
5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred
1-2 Years Leadership/management Experience Strongly Preferred
Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership
Previous experience in precepting and mentoring pharmacy students and residents is desirable
Benefits
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
Company
SCAN
About SCAN Keeping Seniors Healthy and Independent–that’s been our mission for more than 40 years.
1001-5000 employees
H1B Sponsorship
SCAN has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (5)
2024 (3)
2023 (6)
2022 (6)
2021 (5)
2020 (6)
Funding
Current Stage
Late StageLeadership Team
Lyn Amor Macaraeg
CVP Chief of Staff & Strategic Advisor to the CEO
Sachin H. Jain, MD, MBA
President and CEO, Board Director
Recent News
2025-12-26
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