Humana · 1 month ago
Compliance Lead (Pharmacy)
Humana is a healthcare company providing insurance and healthcare services. The Compliance Lead (Pharmacy) develops and implements compliance policies and procedures for Medicare Part B and D, researches regulatory requirements, and supports pharmacy compliance across PBM operations, dispensing, and delegated partners. The role also oversees audits, risk assessments, monitoring, regulatory communications, and corrective action plans.
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Responsibilities
Research compliance issues, interpret and recommend changes that ensure compliance with contract obligations and regulator guidance
Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external partners to support Pharmacy including Medicare Part D with support of Associate Director
Assist in the development of strategy and provide ongoing oversight and monitoring of Pharmacy performance including Medicare Parts B and D and related areas, to ensure full compliance and minimize risk for the Enterprise
Assist the Associate Director and Manager in the completion of risk assessments, with latitude in shaping annual work plans to audit and monitor pharmacy performance of areas within the scope of the position for Medicare Parts B and D
Complete work functions in assigned areas such as the Medicare Prescription Payment Plan, Integrated Dual Eligible Special Needs Plans (AIP D-SNP), new implementations/CMS initiatives and interpreting complex regulatory guidance to advise pharmacy aligned business areas
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
Participate in regulator audits, working with business partners, First-line Risk and other RC teams
Maintain relationships with government agencies and participate in audits with regulators, coordinate implementation and compliance with corrective action plans
Communicate with and present to outside regulators
Collaborate with the team to review and analyze regulatory and sub-regulatory documents and data, identifying materials that demonstrate compliance with regulatory standards
Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts
Work on assignments involve complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors
Perform assessments, develop action plans, and provide guidance to internal business units
Build relationships with pharmacy business units
Provide support for the Manager and Senior associates within the team
Qualification
Required
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
Up to 5% travel may be required, including occasional travel outside your state of residence, to support participation in regulatory audits
Preferred
PharmD, Juris Doctorate, or master's degree
Certification in healthcare compliance (CHC, CCEP) or similar
Benefits
This position is remote; however, candidates residing in and around the Louisville, KY area may have the option to work in a hybrid home/office arrangement.
Some flexibility in Monday–Friday work hours, 8:30am–5:00pm Eastern Standard Time (EST).
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon 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
Company
Humana
Health insurance and Medicare coverage provider.
Funding
Current Stage
Public CompanyTotal Funding
$14.07BKey Investors
JPMorgan Chase & Co.
2026-08-10Post Ipo Secondary
2026-03-05Post Ipo Debt· $1B
2025-05-30Post Ipo Debt· $5B
Leadership Team
Jim Rechtin
CEO and President
Greg Sheff
Interim Segment President, Home Solution
Recent News
Tech Funding News
2026-09-04
2026-09-04
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