Compliance Lead - Government Pharmacy Benefit Management

Position Overview

• Location Type: Not Specified
• Employment Type: Not Specified
• Salary: Not Specified

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.

This role will establish and oversee the comprehensive compliance program infrastructure for our pharmacy benefit management operations, with specialized focus on government healthcare programs including Medicare Part D, Medicaid, and ACA marketplace plans. This high-visibility position is critical for establishing program credibility, ensuring operational integrity, and maintaining adherence to complex federal and state regulatory requirements.

Key Responsibilities

• Compliance Program Development:
  • Establish and maintain comprehensive compliance program infrastructure meeting CMS requirements.
  • Develop and implement compliance policies, procedures, and internal controls for all PBM operations.
  • Create written compliance plans incorporating the seven elements of an effective compliance program.
  • Design and oversee compliance training programs for all staff levels.
  • Establish compliance committee structure and governance framework.
• Regulatory Monitoring & Oversight:
  • Monitor evolving federal and state regulations affecting PBM operations.
  • Interpret CMS guidance, HPMS Memos, DHHS-OIG advisories, and state regulatory updates.
  • Develop compliance monitoring protocols and oversight mechanisms.
  • Create regulatory change management processes to assess operational impact.
  • Maintain regulatory compliance calendar for all reporting requirements.
• Audit & Risk Management:
  • Develop comprehensive audit frameworks for CMS, state Medicaid, and internal compliance and readiness reviews.
  • Prepare organization for CMS program audits across all audit domains (ODAG, CDAG, formulary administration).
  • Create mock audit programs and readiness assessments.

Requirements

Not Specified

Application Instructions

Not Specified

Company Information

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.