Director, PBM Compliance and Regulatory Affairs

Accountabilities: Research and monitor federal and state regulatory developments, anticipate business requirements, identify potential risks, and communicate relevant implications to key stakeholders. Develop strategic compliance plans, policies, and procedures to address regulatory obligations and mitigate business risks. Oversee business registration and licensing requirements across applicable jurisdictions, including preparing and submitting applications, renewals, regulatory reports, and other required documentation. Partner with department leaders to ensure compliance with statutory and regulatory requirements, pharmacy compliance activities, and PBM-specific initiatives. Develop, maintain, and oversee department-approved regulatory and legislative compliance plans, including effective internal controls, policies, and procedures. Review vendor, client, and other business agreements to ensure contractual terms and conditions align with applicable federal and state regulations. Track and communicate compliance policies, procedures, performance obligations, reporting requirements, and key metrics across departments. Serve as a compliance subject matter expert on mandated projects, escalated matters, and operational initiatives, supporting compliance with PBM accreditation requirements. Monitor regulatory developments across applicable jurisdictions and lead the development of organizational positions and responses to proposed or emerging regulatory initiatives. Design and deliver compliance training and communication programs, provide consultation to internal teams, and lead both planned and ad-hoc compliance projects. Provide strategic compliance guidance to clients and business partners, promoting regulatory accountability and operational excellence. Identify opportunities to strengthen regulatory programs and processes, collaborate with stakeholders on improvement initiatives, and recommend practical solutions. Lead and coordinate internal and external audits, including regulatory and client audits, responses to findings, and related remediation activities. Lead, mentor, and develop compliance professionals and people leaders through coaching, performance management, succession planning, and talent development. Requirements: Bachelor's degree required; a master's degree is preferred. A Juris Doctor (JD) degree or an equivalent combination of practical experience is also required. At least 7 years of relevant professional experience in the healthcare industry, with Pharmacy Benefit Manager (PBM) experience strongly preferred. Strong understanding of healthcare compliance, regulatory affairs, and applicable federal and state requirements. Experience developing and implementing compliance programs, policies, procedures, and internal controls. Knowledge of business registration, licensing, regulatory reporting, pharmacy compliance, and PBM accreditation requirements. Demonstrated ability to conduct regulatory research, interpret complex requirements, assess risks, and translate findings into actionable recommendations. Experience managing internal and external audits, regulatory reviews, and remediation activities. Strong project management, organizational, and analytical skills, with the ability to manage multiple priorities in a fast-paced and evolving environment. Excellent written and verbal communication skills, including the ability to explain complex regulatory matters clearly to diverse stakeholders. Proven ability to influence and collaborate across departments, including with leaders and colleagues outside direct reporting structures. Strong independent judgment, attention to detail, intellectual curiosity, and a proactive approach to identifying and addressing risks. Ability to work autonomously while maintaining effective relationships and managing competing deadlines. Demonstrated leadership capabilities, including the ability to coach, motivate, and develop teams. Advanced computer proficiency and strong working knowledge of Windows-based systems. Empathetic, thoughtful, and organized approach, with the confidence to challenge existing practices and recommend better solutions. Benefits: Annual base salary of $185,000–$220,000. Additional bonus and equity opportunities. Final compensation determined by geographic location, professional experience, and qualifications. Opportunity to lead and shape a growing compliance function with significant organizational impact. Collaborative, mission-driven environment focused on improving healthcare experiences and outcomes. Opportunity to work across healthcare, pharmacy, regulatory, and technology teams. Inclusive workplace that values diverse perspectives, backgrounds, and professional experiences. 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