Director, Compliance Part D – Pharmacy Oversight

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $136.4k - $177.4k / year

⏰ Full Time

🔴 Lead

🚔 Compliance

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InnovAge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

InnovAge is a provider of the Program of All-inclusive Care for the Elderly (PACE) that helps frail seniors remain independent and age in their own homes with dignity. As the largest PACE provider by participants served, InnovAge delivers comprehensive, coordinated services including primary care, nursing, behavioral health, therapies, transportation and care coordination to support seniors' medical and daily living needs.

📋 Description

• Lead the design, implementation, and continuous improvement 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 board of pharmacy rules • Ensure policies, procedures, and workflows align with applicable laws, CMS guidance, and industry best practices • Oversee pharmacy and Part D quality reporting, formulary management, medication errors, medication-related appeals and grievances, pharmacy licensure, and pharmacy operations • Develop and execute annual compliance audits and monitoring plans • Prepare for and lead or participate in CMS program audits, mock audits, and internal readiness reviews • Identify compliance gaps and root causes; develop corrective action plans and 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 1/3rd 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 deliver compliance training for pharmacy staff, clinical teams, and leadership • 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 • Serve as 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 results, and corrective actions • Partner with pharmacy operations, clinical teams, quality, legal, IT, and vendor management • Support product development, formulary changes, and benefit design with regulatory guidance • Collaborate 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

• Bachelor’s degree 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 leading audits, managing corrective action plans, and interacting with regulators • Deep understanding of pharmacy operations, formulary management, utilization management, and claims processing • Strong analytical, investigative, and problem solving skills • Excellent communication and leadership abilities • Ability to influence cross functional teams and drive compliance culture • High integrity, sound judgment, and commitment to ethical conduct • Overnight travel out of state • Florida applicants must complete 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