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Be ready to walk through a pharmacy compliance investigation or CAP: risk identified, evidence gathered, stakeholders engaged, and outcome. Expect scenario questions on FWA red flags, formulary/utilization edits, and how you balance member access with plan obligations at a large insurer like Humana.
Strong fit if you already work health-plan or PBM pharmacy compliance and want senior ownership inside a major national insurer. Weaker fit if you need remote work, pure clinical pharmacy without regulatory depth, or a role centered only on corporate HQ life in Louisville.
As a Senior Compliance Professional focused on pharmacy at Humana, a typical day centers on interpreting Medicare/Medicaid and commercial pharmacy rules, reviewing PBM and benefit-design controls, and flagging gaps before claims or member communications go live. You would partner with pharmacy operations, legal, and audit teams; document findings; track corrective actions; and support regulatory or internal reviews that keep Humana’s pharmacy programs within policy and contract requirements.
Prioritize health-plan pharmacy compliance (Medicare Part D / Medicaid pharmacy rules), audit readiness, CAP management, and clear written findings. No certification resources were supplied for this listing—treat any credential path as optional and verify costs independently.
The listing marks remote as no and places the job in Wyoming, Kent County, Michigan—plan on local or on-site expectations unless Humana later clarifies hybrid details.
It typically means ensuring pharmacy benefits, utilization, and vendor processes meet federal/state rules and plan contracts, then documenting and remediating issues—not primarily dispensing medications.
Humana is a major U.S. health insurer headquartered in Louisville; knowing Medicare Advantage/pharmacy benefit context and recent pharmacy-cost partnerships is more useful than general tech-hiring chatter.
Website: humana.com
Humana Inc. is an American for-profit health insurance company based in Louisville, Kentucky. In 2024, the company ranked 92 on the Fortune 500 list, which made it the highest ranked company based in Kentucky. It is the fourth largest health insurance provider in the U.S.
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Senior Compliance Professional (Pharmacy) at Humana in Wyoming, Kent County About the Role The Senior Compliance Professional plays a crucial role in ensuring adherence to government regulations and requirements. This position involves work assignments of moderate to high complexity, requiring comprehensive analysis and evaluation of variable factors and data. The primary focus is on compliance related to Medicare Pharmacy and Part D programs. Day-to-Day Responsibilities Evaluate and monitor compliance with federal and state regulations for Medicare Pharmacy and Part D programs. Conduct audits and reviews to identify potential areas of non-compliance and recommend corrective actions. Develop and maintain policies, procedures, and guidelines to ensure ongoing compliance. Collaborate with internal teams and external stakeholders to address regulatory changes and implement necessary adjustments. Qualifications Minimum of 5 years of experience in pharmacy compliance or related field. Strong knowledge of Medicare Pharmacy and Part D regulations, policies, and procedures. Possession of a Bachelor's degree; advanced degree preferred. Excellent analytical, problem-solving, and communication skills. Working at Humana Join our caring community where we prioritize the well-being of our members. As part of the team, you will have opportunities for professional growth and development in a supportive work environment. How to Apply To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.
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