Director, Compliance Part D Pharmacy Oversight

The Compliance Director for Pharmacy and Part D Oversight is responsible for leading developing and maintaining a comprehensive compliance program that ensures adherence to federal and state regulations governing pharmacy operations and Medicare Part D. This role provides strategic direction oversight and subject matter expertise to safeguard organizational integrity reduce regulatory risk and promote a culture of compliance across all pharmacy and Part D functions.

Essential Functions and Work Responsibilities

Functional Category:Compliance

Estimated Percent of time Spent 100%

Key Responsibilities:

Regulatory Compliance & Oversight

• Lead the design implementation and continuous improvement of the organizations pharmacy and Medicare Part D compliance program.
• Monitor and interpret federal and state regulatory requirements including CMS Part D regulations DEA FDA and state board of pharmacy rules.
• Ensure organizational policies procedures and operational workflows align with applicable laws CMS guidance and industry best practices.
• Oversee compliance with pharmacy and Part D quality reporting formulary management medication errors medication related appeals and grievances pharmacy licensure and pharmacy operations.

Audit & Monitoring

• Develop and execute annual compliance audits and monitoring plans for pharmacy and Part D operations.
• Prepare for and Lead/Participate in CMS program audits mock audits and internal readiness reviews.
• Identify compliance gaps root causes and corrective action plans; track remediation to completion.
• Oversee delegated entity oversight including credentialing monitoring and performance evaluation of PBMs pharmacies and other vendors.
• Assist with organizational matters regarding 1/3^rdaudits.

Risk Management

• 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 and ensure sustainable adherence.

Training & Education

• Develop and deliver compliance training programs for pharmacy staff clinical teams and leadership as needed.
• Ensure employees understand regulatory obligations reporting mechanisms and compliance expectations.
• Attend and participate in relevant pharmacy and Part D committees via external partners such as NPA.
• Govern an internal Part D committee with oversight of Part D Fraud Waste and Abuse (FWA) reviewing areas such as medication utilization medical documentation and PBM oversight.

Reporting & Governance

• Serve as the compliance liaison for pharmacy and Part D matters 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 results and corrective actions.

Cross Functional Collaboration

• Partner with pharmacy operations clinical teams quality legal IT and vendor management to ensure compliant processes and systems.
• Support product development formulary changes and benefit design with regulatory guidance.
• Collaborate with data analytics teams to monitor key compliance metrics and identify trends.

Travel Requirements

Travel

Estimated Percent of time Spent 15%

Qualifications

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Education

• Bachelors degree required; advanced degree (PharmD MBA MHA JD) preferred.
• 710 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 leading audits managing corrective action plans and interacting with regulators.

Skills & Competencies

InnovAge is dedicated to empowering seniors to live independently allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE) which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge youll work alongside talented respectful and passionate colleagues within a patient-centered care model.

InnovAge is committed to equal opportunity and affirmative action and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race color religion sex sexual orientation gender identity/expression national origin disability protected veteran status pregnancy or any other protected status. Salaries are determined by various factors such as qualifications experience and location and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance short and long-term disability life insurance and AD&D supplemental life insurance flexible spending accounts 401(k) savings paid time off and company-paid holidays.

Applicants are considered until the position is filled.

Compensation Disclaimer

The pay may vary depending on job related factors such as work location experience knowledge skills education certifications training and internal equity. InnovAge offers a comprehensive benefits package which includes medical dental vision 401(k) plan with company match short and long-term disability life insurance supplemental life insurance ADD flexible spending account paid time off and company paid holidays.

Attention Florida Applicants
This position requires a background screening through the Florida Care Provider Background Screening Clearinghouse.
For more information please visit the Clearinghouse Education and Awareness website:

Agency Disclaimer

InnovAge will not accept unsolicited resumes from search firms for this employment opportunity. Regardless of past practices all candidates/resumes submitted by search firms to InnovAge by any means without a valid written search agreement in place for that position will be deemed the property of InnovAge and no fee will be paid in the event such candidate is hired by InnovAge.

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