Director, Compliance Part D / Pharmacy Oversight
Job Description
Responsibilities
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 organization’s 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 1/3rd audits.
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%
- Travel between local InnovAge worksites
- Travel to client and potential client homes and/or other off-site locations
- Overnight travel out of state
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
REQUIRED
Education
- Bachelor’s degree required; advanced degree (PharmD, MBA, MHA, JD) preferred.
- 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.
Skills & Competencies
- 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.
