Manager, Compliance

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Job Description

Summary:

The Manager, Compliance ensures compliance with governmental requirements. The Manager, Compliance works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex 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 related 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 oversee 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 within the team. The Manager work assignments involve moderately complex to complex 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 latitude in creating annual work plans to audit and monitor pharmacy performance of areas within the scope of the position for Medicare Part

D.

While working within assigned areas to optimize business results, the Lead will:

• Assist in the development of strategy and provide on-going oversight and monitoring of Pharmacy performance including Medicare Part D and related areas, to ensure full compliance and minimize risk for the Enterprise;
• Have latitude 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 Humana Departments and/or external business partners in support of Pharmacy including Medicare Part D with support of Associate Director;
• Communicate with and present to outside regulators;
• Oversee 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;
• Oversee 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 Humana operational units and product lines to enhance data analytics and operational improvement efforts;
• Perform assessments, develop 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 make an impact

• 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-related, risk management and/or managed care-related 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

• Graduate or advanced degree or equivalent work experience

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

40

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.

$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.

Humana, Inc. and its affiliated subsidiaries (collectively,…