Compliance Lead - Government Pharmacy Benefit Management

Job Description

RxSense is seeking a Compliance Lead to establish and oversee the compliance program for its pharmacy benefit management operations, focusing on government healthcare programs. This role is crucial for ensuring operational integrity and adherence to federal and state regulations.Responsibilities:

• Establish and maintain comprehensive compliance program infrastructure meeting CMS requirements
• Develop and implement compliance policies, procedures, and internal controls for all PBM operations
• Monitor evolving federal and state regulations affecting PBM operations
• Develop comprehensive audit frameworks for CMS, state Medicaid, and internal compliance and readiness reviews
• Ensure Medicare Part D compliance
• Manage Medicaid compliance requirements
• Oversee ACA marketplace compliance
• Conduct risk assessments across all operational areas
• Serve as primary compliance liaison with CMS and state regulators

Requirements:

• Bachelor's degree required; JD, Master's in Healthcare Administration, or related advanced degree preferred
• 8+ years of healthcare compliance experience, with 5+ years in PBM or managed care
• 5 + years of experience with Medicare Part D compliance programs
• Expert knowledge of Medicare Part D regulations and CMS requirements
• Deep understanding of Medicaid pharmacy benefit regulations
• Familiarity with ACA requirements affecting PBMs

RxSense offers:

• A remote work environment
• Opportunity to work with a leading healthcare technology company