Senior Compliance Professional (Pharmacy)

Become a part of our caring community The Senior Compliance Professional ensures adherence to government regulations and requirements. Your role will involve work assignments of moderate to high complexity, requiring comprehensive analysis and evaluation of variable factors and data. The primary focus of this position is compliance related to Medicare Pharmacy and Part D programs. The Senior Compliance Professional will analyze business requirements, conduct research, and provide regulatory interpretation to advise internal business units and external business partners. This guidance supports the delivery of results that minimize compliance risk exposure for Humana . You will be responsible for developing and maintaining key relationships with Humana operational leaders and external business partners. The primary focus of this role is to develop and implement monitoring and auditing plans for business processes. The objective of these plans is to prevent, detect, and resolve compliance issues related to Humana 's pharmacy services across segments. While working within assigned areas to optimize business results, the Senior Compliance Professional will: Oversee pharmacy compliance for the Centers for Medicare & Medicaid Services (CMS) Program Audit focused areas, including but not limited to Formulary Administration, Coverage Determination, and Organization Determination (Part B drugs) functions. Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives. Research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments. Conduct risk assessments and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations. Develop and track compliance metrics to help monitor and detect potential compliance is