Director, Compliance Part D – Pharmacy Oversight

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead the design, execution, and ongoing enhancement of the pharmacy and Medicare Part D compliance program.

• Monitor and interpret federal and state regulatory requirements, including CMS Part D regulations, DEA, FDA, and state pharmacy board rules.

• Ensure that policies, procedures, and workflows comply with relevant laws, CMS guidance, and industry best practices.

• Oversee quality reporting for pharmacy and Part D, formulary management, medication errors, medication-related appeals and grievances, pharmacy licensure, and pharmacy operations.

• Develop and implement annual compliance audits and monitoring plans.

• Prepare for and either lead or participate in CMS program audits, mock audits, and internal readiness reviews.

• Identify compliance gaps and root causes; create corrective action plans and monitor remediation until completion.

• Supervise delegated entity oversight, including credentialing, monitoring, and performance evaluation of PBMs, pharmacies, and other vendors.

• Assist with organizational matters regarding one-third audits.

• Conduct ongoing risk assessments related to pharmacy operations, Part D benefit administration, and delegated functions.

• Advise executive leadership on emerging risks, regulatory changes, and operational vulnerabilities.

• Implement controls to mitigate compliance risks.

• Develop and provide compliance training for pharmacy staff, clinical teams, and leadership.

• Attend and engage in relevant pharmacy and Part D committees through external partners such as NPA.

• Manage an internal Part D committee overseeing Part D Fraud, Waste, and Abuse.

• Act as the compliance liaison with CMS, state regulators, PBMs, and internal stakeholders.

• Prepare compliance reports for executive leadership, compliance committees, and the board.

• Maintain documentation and evidence of compliance activities, audit outcomes, and corrective actions.

• Collaborate with pharmacy operations, clinical teams, quality, legal, IT, and vendor management.

• Support product development, formulary modifications, and benefit design with regulatory guidance.

• Work with data analytics teams to monitor compliance metrics and identify trends.

• Travel between local InnovAge worksites and to client and potential client homes or other off-site locations.

⛳️ Requirements

• A Bachelor’s degree is required.

• 7–10+ years of experience in pharmacy compliance, Medicare Part D operations, PBM oversight, or related regulatory roles.

• Strong knowledge of CMS Part D regulations, pharmacy benefit administration, and healthcare compliance frameworks.

• Experience in leading audits, managing corrective action plans, and engaging with regulators.

• In-depth understanding of pharmacy operations, formulary management, utilization management, and claims processing.

• Strong analytical, investigative, and problem-solving skills.

• Excellent communication and leadership capabilities.

• Ability to influence cross-functional teams and foster a compliance culture.

• High integrity, sound judgment, and a commitment to ethical practices.

• Willingness to travel overnight out of state.

• Florida applicants must undergo a background screening through the Florida Care Provider Background Screening Clearinghouse.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Short- and long-term disability insurance.

• Life insurance and AD&D.

• Supplemental life insurance.

• Flexible spending accounts.

• 401(k) savings plan with company match.

• Paid time off.

• Company-paid holidays.

• Equal opportunity and affirmative action workplace.

• Diverse and inclusive workplace.

• Patient-centered care model.

• Comprehensive benefits package.