Director, Compliance Part D / Pharmacy Oversight

About the Role

This position leads, develops, and maintains a comprehensive compliance program ensuring adherence to federal and state regulations governing pharmacy operations and Medicare Part D. The 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.

Responsibilities

• 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.
• 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.
• 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.
• Develop and deliver compliance training programs for pharmacy staff, clinical teams, and leadership.
• Ensure employees understand regulatory obligations, reporting mechanisms, and compliance expectations.
• 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.
• 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.
• 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

• 15% estimated travel time.
• Travel between local InnovAge worksites.
• Travel to client and potential client homes and/or other off-site locations.
• Overnight travel out of state.

Requirements

• 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.

Benefits

• Medical, dental, and vision insurance.
• Short- and long-term disability, life insurance, and AD&D.
• Supplemental life insurance.
• Flexible spending accounts.
• 401(k) savings plan with company match.
• Paid time off and company-paid holidays.

Pay

Posted pay range: $136,400 - $177,400.