Manager, Pharmacy Compliance

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.

SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

Job Description:

This position will play a central role in designing and executing the Part D program for coverage determinations, appeals, and grievances for a senior-focused Medicare Advantage Plan. The Supervisor will be responsible for ensuring CMS compliance with regard to operations, star rating performance, and enhanced member/provider experience, and will also provide leadership support and direction to the team, ensuring appropriate oversight of the contracted pharmacy benefit manager (PBM).

You Will

Lead and support CMS Part C and D Program Audits, Data Validation Audits, manage Universe Files, oversee HPMS reporting (CDR, IDUC, Appeals, Grievances), and monitor audit preparedness through mock audits and post-submission review.

Supervise the Pharmacy Experience & Access team to oversee and optimize PBM delegated programs (concurrent DUR, retroDUR, FWA, Patient Safety Analysis, Opioids) for compliance and effectiveness.

Ensure CDAG operations (coverage determinations, appeals, grievances) are timely, compliant, and effective, preventing ICARs, CMPs, and data accuracy issues.

Implement process enhancements that strengthen compliance, efficiency, and member experience through routine tracking and trending.

Maintain up-to-date clinical policies and SOPs, ensuring internal adherence across clinical operations.

Serve as subject matter expert for Part D coverage determinations, redeterminations, grievances, and Part C organization determinations.

Stay current with Medicare Part D regulations by attending CMS calls and applying released guidance to maintain compliance.

Oversee PBM operations, collaborating on process improvements and CMS updates to support quality performance and enhance member experience.

Provide supervision, development, and coaching to pharmacists, technicians, and support staff, fostering a culture of process improvement, operational excellence, and compliance.

Act as Residency/APPE Director, setting expectations, appraising performance, and supporting student/resident pharmacists and their preceptors.

Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Actively support the achievement of SCAN's Vision and Goals.

Other duties as assigned.

Your Qualifications

Bachelor's Degree required. PHARMD or equivalent.

Required Certifications or Licenses: Pharmacists (PHs)

Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice experience.

Demonstrated knowledge of and experience monitoring Medicare Part D regulations, required.

5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred.

1-2 years leadership/management experience strongly preferred.

Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership.

Previous experience in precepting and mentoring pharmacy students and residents is desirable.

Leadership - Lead and inspire teams to achieve performance goals, offering guidance and support

Problem Solving - Good problem-solving skills

Communication - Good communication and interpersonal skills

Strong analytical, problem-solving, and decision-making abilities - Ability to think strategically while executing tactically - Detail-oriented and highly adaptable to a fast-paced, evolving environment - Demonstrated ability to manage multiple priorities simultaneously

Proven leadership, supervisory, and accountability skills - Strong organizational, time management, and project management capabilities - Self-starter with a resourceful and innovative mindset - Effective across cross-functional teams and collaborative environments

Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions

Communication & Professionalism - Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions

What's in it for you?

• Base salary range: $147,900.00to $214,030.00 per year
• Work Mode - Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day

We're always looking for talented people to join our team Qualified applicants are encouraged to apply now

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)