Compliance Lead - Government Pharmacy Benefit Management - Remote

Overview

RxSense is a leading healthcare technology company delivering innovative solutions for pharmacy benefits and prescription savings. Our enterprise platform brings transparency, flexibility, and efficiency to pharmacy benefit management, helping clients streamline operations and enabling consumers to save on prescriptions. By integrating intelligence across the pharmacy ecosystem, RxSense makes cost-effective healthcare more accessible. Whether for PBMs, pharmacies, or individuals, our solutions help modernize operations, reduce costs, and improve outcomes.

RxSense also owns and operates SingleCare, a free prescription savings service that offers consumers access to consistently low prices on prescription drugs. Through its partnerships with the country’s largest pharmacies and grocers, including CVS, Walgreens, Walmart, Kroger and Albertsons, SingleCare improves access and adherence to affordable medications and has helped millions of Americans save over $11 billion on their medications.

RxSense is a great place to work! Our company has earned several prestigious awards, including Fast Company’s Most Innovative Companies, Forbes’ Top Startup Employers, Modern Healthcare's Best Places to Work in Healthcare, and Inc’s Best in Business and Best Workplaces.

In Short

• Establish and oversee compliance program infrastructure for pharmacy benefit management operations.
• Develop and implement compliance policies, procedures, and internal controls for all PBM operations.
• Monitor federal and state regulations affecting PBM operations.
• Develop compliance monitoring protocols and oversight mechanisms.
• Conduct risk assessments and develop risk mitigation strategies.
• Ensure compliance with Medicare Part D, Medicaid, and ACA marketplace plans.
• Serve as primary compliance liaison with CMS and state regulators.
• Prepare the organization for CMS program audits.
• Manage relationships with external auditors and compliance consultants.
• Foster a compliance culture across the organization.

Requirements

• Bachelor's degree required; advanced degree preferred.
• 8+ years of healthcare compliance experience, with 5+ years in PBM or managed care.
• Expert knowledge of Medicare Part D regulations and CMS requirements.
• Experience with compliance monitoring tools and audit software.
• Proven ability to build and lead compliance teams.

Benefits

• Competitive salary and benefits.
• Opportunities for professional development.
• Work in a diverse and inclusive environment.
• Access to innovative healthcare solutions.
• Join a recognized leader in healthcare technology.