Compliance Lead (Pharmacy)
$115.2k - $158.4kHumana Inc
- # Compliance Lead (Pharmacy)Applylocations: Remote Nationwidetime type: Full timeposted on: Posted Yesterdayjob requisition id: R-425881# **Become a part of our caring community**The Compliance Lead (Pharmacy) ensures compliance with governmental requirements. You will 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. Your decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving your own departmental area. These projects and initiatives will require cross departmental collaboration. Additionally, you conduct briefings and area meetings; you also maintain frequent contact with other compliance associates across the department. You will report directly to the Associate Director of Compliance. You will support the entire Pharmacy Compliance team in areas including our PBM (Pharmacy Benefit Manager) operations, specialty and mail-order dispensing, and key delegated partners.The Compliance Lead (Pharmacy) develops and implements 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.* 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.# **Use your skills to make an impact****Required Qualifications*** 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.**Preferred Qualifications*** PharmD, Juris Doctorate, or master's degree.* Certification in healthcare compliance (CHC, CCEP) or similar.**Additional Information*** **Workstyle:** 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.* **Travel:** Up to 5% travel may be required, including occasional travel outside your state of residence, to support participation in regulatory audits.* **Typical Workdays and Hours:** Monday – Friday; 8:30am – 5:00pm Eastern Standard Time (EST) with some flexibility.Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.**Scheduled Weekly Hours**40**Pay Range**The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$115,200 - $158,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.**Description of Benefits**Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 11-06-2026
- J-18808-Ljbffr Humana Inc
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Compliance Lead (Pharmacy) in Louisville, KY vacancy
- Humana Inc is seeking a Compliance Lead (Pharmacy) to ensure Medicare Part B and Part D compliance, working across PBM operations, specialty and mail-order dispensing, and external partners. The role requires a Bachelor's degree and 5 years of pharmacy claims/compliance...SuggestedRemote work
$12 - $24.33 per hour
...completing the work within the store. Ensures all team members receive the appropriate training and education, including ongoing compliance training. Acts as leader on duty, responding to customer and team member concerns in the absence of the Store Manager, as well as...SuggestedFull timeFlexible hoursAfternoon shiftFollett
Louisville, KY3 days ago$115.2k - $158.4k
...Become a part of our caring community The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Compliance Lead serves as the dedicated Compliance...SuggestedFull timeContract workTemporary workHumana
Louisville, KY3 days ago- ...within our Heavy Maintenance Division. You will coordinate crew members and subcontractors, manage schedules, and ensure safety and compliance on every project. Applicants should have experience in the petroleum industry or related fields, be able to lift heavy loads,...SuggestedFor subcontractor
SPATCO
Louisville, KY3 days ago - CVS Health in Louisville, KY is seeking a Pharmacy Manager to lead a pharmacy team and deliver high-quality patient care. You will oversee dispensing, counseling, immunizations, and regulatory compliance while coaching staff and optimizing workflow. The role requires an...SuggestedFull time
- ...our Louisville, KY Fulfillment Center and Pharmacy. This role places you on the site... ...our results.What you’ll do:Develop and lead maintenance technicians responsible for... ...documentation, equipment readiness, and compliance with applicable pharmacy, safety, and quality...Local areaFlexible hoursNight shift
- ...seeking a pharmacist to support the Community Pharmacy Manager with staff direction and to deliver high-quality patient care. You will lead and collaborate with pharmacy staff to... ...dispensing services while maintaining compliance with regulatory requirements. The role emphasizes...
- PharMerica is seeking a Pharmacy Lead Prior Authorization Coordinator to manage prior authorization workflow and collaborate with prescribers... ...approvals, participate in policy updates, and maintain compliance with government regulations while supporting a high standard...
- ...implement strategic initiatives for parish-based Conferences within the Society. You will lead volunteer recruitment and development, support Conference growth, and ensure compliance with National Council standards and 501(c)(3) requirements. The role emphasizes data-...
- ...Supervisor to oversee the security shift, ensuring safety for guests, Team Members, and company assets. You will lead security operations, monitor compliance, and coordinate response to incidents. The role supports recruitment processes, schedules training, and conducts...Shift work
- Job Description Zone Lead (Full-Time) Job Summary The Zone Lead (ZL) reports to the Assistant Store Manager and supports merchandising... ...always demonstrating a culture of ethical conduct, safety, and compliance. The ZL’s responsibilities require enthusiasm for vigorous...Full timeFlexible hoursShift workNight shift
- Trilogy Health Services in Kentucky is seeking a Billing Team Lead to oversee billing operations, lead a team of billing associates,... ...Experience in billing and familiarity with billing systems is preferred, and CPHT certification is a plus. #J-18808-Ljbffr Synchrony Pharmacy
- ...Team Lead The Team Lead assists in supervising and managing all day-to-day store operations while ensuring that 100% compliance exists with all established Company policies and procedures. Provides leadership, guidance and training to the store staff via direction from...Full timePart time
- A leading staffing and consulting firm is seeking an experienced Senior Payroll Manager in Louisville, Kentucky. This contract role involves leading payroll operations and ensuring compliance in a fast-paced environment. The ideal candidate will have over 7 years of payroll...Contract workImmediate start
- ...and administration. The role involves supporting the Board and executive leadership, facilitating communication, and maintaining compliance with regulatory standards. Ideal candidates should have at least 5 years of experience in executive support and a Bachelor's degree...
- ...time, exempt role manages daily operations, data collection, and compliance, while providing direct student advisement and retention... ...leadership on budgeting, reporting, and strategic planning, and may lead in the director’s absence. #J-18808-Ljbffr University of LouisvilleFull time
- Ferrero in Louisville, KY is seeking a Sanitation Manager to lead and manage the plant's Sanitation program, ensuring compliance with safety and hygiene standards. Responsibilities include maintaining the sanitation budget, supervising two Sanitation Supervisors, and managing...
- Walgreens is seeking a detail-oriented team member to manage store inventory across both front end and pharmacy. You will receive, count, price, and process returns, while maintaining accurate planograms and on-hand balances. The role includes supporting price changes,...Flexible hours
- Pharmacy Alternatives®, an affiliate of PharMerica, is seeking a billing specialist for a hybrid role in Louisville, KY. You will manage pre-billing processes, audit billing accuracy, and support policy adherence while delivering exceptional customer service to hospitals...Shift work
- Humana Inc. is seeking a Senior AI Implementation Lead to architect and deliver enterprise AI capabilities across multiple locations... ...Louisville, KY, while prioritizing data privacy and regulatory compliance. You will lead cross-functional teams to design scalable AI...Remote job
- Pharmacy Alternatives, an affiliate of PharMerica, is seeking a Billing Specialist to join our hybrid team in Louisville, KY. You will... ...pre-billing and reporting processes to ensure accuracy and compliance with policies and government regulations. You will address billing...
- Steel Technologies is seeking an Environmental Manager to lead the development, implementation, and maintenance of a comprehensive... ...sites in the United States. The role involves steering regulatory compliance, audits, and continuous improvement initiatives with strong...
- ...PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the... ...Responsibilities The Pharmacy Lead Prior Authorization Coordinator is responsible... ...authorization functions regularly for compliance to policies, procedures, contract and...Contract workWork at officeFlexible hoursShift work
BrightSpring Health Services
Louisville, KY5 days ago - PharMerica in Louisville, KY seeks Pharmacy Lead Prior Authorization Coordinator to oversee prior authorizations for long-term care prescriptions... ...proficiency with Microsoft Word and Excel, with a focus on compliance, accuracy, and efficient processing in a hybrid work #J-1880...
- ...and mentors a team, and drives modernization including robotics and AI-assisted welding. You will review drawings, ensure ITAR/CUI compliance, and contribute to front-end quoting and process improvements. The role emphasizes safety, quality, and efficiency on the shop...
- ...This in-office role supports the Private Bank, handling complex fiduciary accounts and high-profile relationships while ensuring compliance with fiduciary regulations. The position emphasizes risk management, client communications, and growth of assets under management...Work at office
- Baptist Health is seeking a Patient Engagement Lead Pharmacy Technician for the Central Pharmacy in LaGrange, KY. You will lead prescription entry, insurance processing, and patient outreach for centralized specialty and mail-delivery prescriptions under pharmacist supervision...
- ...Lead Maintenance Technician Chewy is seeking a Lead Maintenance Technician at our pharmacy fulfillment center in Louisville, KY! You will have the opportunity to apply your experience to support the fast-paced operations of our multifaceted fulfillment center environment...Hourly payAll shiftsShift workNight shiftWeekend work
- Overview Our Company Pharmacy Alternatives Overview Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus... ...for improvement. Audit billing functions regularly for compliance to policies, procedures, and contract and government regulations...Contract workInterim roleLive inFlexible hoursShift work
- ...to regulatory guidelines. The successful candidate will possess extensive payroll processing experience, strong knowledge of tax compliance, and the ability to generate insightful payroll reports. Advanced Excel skills and experience with payroll systems such as ADP are...
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Compliance Lead (Pharmacy). Be the first to apply!
Related searches
- compliance technician Louisville, KY
- vendor compliance Louisville, KY
- alcohol compliance Louisville, KY
- affordable housing compliance Louisville, KY
- code compliance Louisville, KY
- entry level regulatory affairs Louisville, KY
- housing compliance Louisville, KY
- labor compliance Louisville, KY
- compliance team leader Louisville, KY
- compliance reviewer Louisville, KY