Become a part of our caring community and help us put health first
 

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
 

Required Qualifications

• 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

Preferred Qualifications

• 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.

Scheduled Weekly Hours

40

Pay Range

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.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) 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 outside of work. Among our benefits, Humana 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: 05-30-2026

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana 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 base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.