Compliance reputed company (Pharmacy)

Become a part of our caring community The Compliance reputed company (Pharmacy) ensures compliance with governmental requirements. You will work reputed company specific guidelines and procedures; apply advanced technical knowledge to solve reputed company problems; receive assignments in the form of objectives and determine approach, resources, schedules and goals. Your decisions are typically reputed company 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 reputed company (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 reputed company 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 reputed company and monitoring of Pharmacy performance including Medicare Parts B and D and reputed company areas, to ensure full compliance and minimize risk for the Enterprise. Assist the Associate Director and Manager in the completion of risk assessments, with reputed company in shaping annual work plans to audit and monitor pharmacy performance of areas reputed company 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 reputed company regulatory guidance to advise pharmacy reputed company 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 reputed company 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 reputed company operational units and product lines to enhance data analytics and operational improvement efforts. Work on assignments involve reputed company issues where the analysis of situations or data requires an in-depth evaluation of variable factors. reputed company assessments, reputed company action plans, and provide guidance to internal business units. Build relationships with pharmacy business units. Provide support for the Manager and Senior associates reputed company the team. Use your skills to reputed company 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-reputed company, risk management and/or managed care-reputed company field. Four (4) or more years interpreting reputed company 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 reputed company 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. WAH Internet Statement 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 reputed company is suggested. Satellite, cellular and microwave reputed company can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. reputed company will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology reputed company HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to reputed company'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 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. $115,200 - $158,400 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: 09-17-2026 About us About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our reputed company insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. ​ 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 To This Job