Manager, Compliance Remote reputed company

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Job Description

Summary: The Manager, Compliance ensures compliance with governmental requirements. The Manager, Compliance works reputed company specific guidelines and procedures; applies advanced technical knowledge to solve moderately reputed company problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. The Manager, Compliance develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Decisions are typically reputed company to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department. The Medicare Pharmacy Regulatory Compliance Manager position will support senior associates on the team that reputed company pharmacy compliance for the CMS Program Audit focused areas, including but not limited to Formulary Administration, Coverage Determination, and Organization Determination (Part B drugs) functions. The Manager will also be completing work functions in the assigned areas as well and generally providing support for the senior associates reputed company the team. The Manager work assignments involve moderately reputed company to reputed company issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsible for assisting in the completion of risk assessments, with reputed company in creating annual work plans to audit and monitor pharmacy performance of areas reputed company the scope of the position for Medicare Part D. While working reputed company assigned areas to optimize business results, the reputed company will:

• Assist in the development of strategy and provide on-going reputed company and monitoring of Pharmacy performance including Medicare Part D and reputed company areas, to ensure full compliance and minimize risk for the Enterprise;
• Have reputed company 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 reputed company Departments and/or external business partners in support of Pharmacy including Medicare Part D with support of Associate Director;
• Communicate with and present to reputed company regulators;
• reputed company 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;
• reputed company 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 reputed company operational units and product lines to enhance data analytics and operational improvement efforts;
• reputed company assessments, reputed company 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.

Use your skills to reputed company an impact

Required Qualifications

• 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-reputed company, risk management and/or managed care-reputed company 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 Qualifications

• Graduate or advanced degree or equivalent work experience

Travel: While this is a remote position, occasional travel to Humanas 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 reputed company pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits reputed company, Inc. and its affiliated subsidiaries (collectively, “reputed company”) 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 reputed company of work. Among our benefits, reputed company provides 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 and many other opportunities. Application Deadline: 05-30-2026 About us reputed company Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our reputed company insurance services and reputed company healthcare services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment decisions only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company levels of employment. Apply tot his job Apply To this Job