Humana · 13 hours ago
Manager, Compliance
United States
Full-time
Remote
Mid, Senior Level
$104K/yr - $143K/yr
7+ years expHumana Inc. is committed to putting health first, and they are seeking a Manager, Compliance to ensure adherence to governmental requirements. This role involves developing compliance policies, maintaining relationships with government agencies, and overseeing pharmacy compliance for Medicare Part D programs.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Develop and implement compliance policies and procedures
Research compliance issues and recommend changes that assure compliance with contract obligations
Maintain relationships with government agencies
Coordinate site visits for regulators, coordinate implementation and compliance with corrective action plans, as needed
Assist in the completion of risk assessments, with latitude in creating annual work plans to audit and monitor pharmacy performance of areas within the scope of the position for Medicare Part D
Assist in the development of strategy and provide on-going oversight and monitoring of Pharmacy performance including Medicare Part D and related areas, to ensure full compliance and minimize risk for the Enterprise
Have latitude and discretion in the completion of risk assessments and creating annual work plans to audit and monitor performance
Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners in support of Pharmacy including Medicare Part D with support of Associate Director
Communicate with and present to outside regulators
Oversee Regulatory Compliance senior professional roles assigned to the position, as well as to assist across the team, to review and analyze market documents and data to identify what can be used to evidence meeting compliance and regulatory standards
Oversee Regulatory Compliance senior professional roles assigned, as well as to assist across the team, to audit and monitor pharmacy and Medicare Part D programs and performance, and report to RC leadership top risks, remediation plans and other information as appropriate
Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts
Perform assessments, develop action plans, and provide guidance to internal business units
Build relationships with pharmacy business units
Coordinate on-site audits, working with business partners and Regulatory Compliance teams
Qualification
Required
Bachelor's degree or 5 years or more years of demonstrated experience in the areas of pharmacy and compliance
3 or more years of experience working in a Compliance-related, risk management and/or managed care-related field
7 years of pharmacy experience in claims operations
1 year of management and/or leadership experience
Strong communication skills with the ability to influence effectively
Experience working with regulatory agencies, including state departments of health insurance and/or CMS
Knowledgeable in regulations governing health care industries
Audit or consulting experience
Knowledge of PBM operations
Preferred
Graduate or advanced degree or equivalent work experience
Benefits
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
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Caleb Gallifant
Chief Operating Officer, CenterWell Home Health
Recent News
2026-01-16
2026-01-16
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