VP, Risk and Pharmacy Compliance
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Job Description
VP, Risk & Pharmacy Compliance at Fuze Health overseeing pharmacy compliance operations across all 50 states. Driving regulatory strategy and fostering a culture of compliance throughout the organization.
Responsibilities:
- Establish and lead an enterprise-wide pharmacy compliance and risk management program aligned with organizational objectives and regulatory requirements
- Serve as the senior compliance advisor to executive leadership on pharmacy regulatory matters, compliance risks, and emerging regulatory trends
- Develop and execute a long-term compliance strategy that supports business growth while maintaining regulatory excellence
- Promote a culture of ethics, integrity, accountability, and compliance across the organization
- Ensure compliance with applicable federal and state laws and regulations, including HIPAA, HITECH, Medicare Part D, Medicaid, state pharmacy regulations, and other healthcare regulatory requirements
- Oversee pharmacy licensing, accreditation, certification, and regulatory reporting activities
- Lead responses to regulatory audits, inspections, investigations, complaints, and inquiries from government agencies and pharmacy boards
- Direct enterprise pharmacy compliance risk assessments and develop risk mitigation strategies
- Identify and proactively address areas of regulatory risk, including drug diversion, fraud, waste and abuse, privacy, data security, and operational compliance
- Oversee compliance monitoring, auditing, and reporting programs to assess effectiveness and identify opportunities for improvement
- Partner with clinical, operations, product, technology, and legal teams to embed compliance requirements into business processes and product development
- Advise leadership on regulatory implications associated with strategic initiatives, new products, partnerships, and expansion opportunities
- Lead, mentor, and develop a high-performing compliance organization
Requirements:
- Bachelor's degree required; advanced degree (JD, PharmD, MPH, MBA, or related field) preferred
- 12+ years of progressive experience in healthcare compliance, pharmacy compliance, regulatory affairs, or risk management within a highly regulated healthcare environment
- Significant leadership experience overseeing enterprise compliance programs and managing teams
- Deep expertise in healthcare regulatory requirements, including HIPAA/HITECH, Medicare, Medicaid, OIG guidance, pharmacy regulations, accreditation standards, and privacy laws
- Experience serving as a senior compliance leader, Compliance Officer, Head of Compliance, VP of Compliance, or similar role within a pharmacy, PBM, health plan, specialty pharmacy, or healthcare organization
- Demonstrated experience managing regulatory audits, investigations, licensing, accreditation, and enterprise risk management initiatives
- Prior experience within a Pharmacy Benefit Manager (PBM), specialty pharmacy, health plan, or large pharmacy organization
- Experience interacting directly with executive leadership, boards, regulators, and accrediting bodies preferred
- Familiarity with regulatory intelligence tools and compliance management systems preferred
- Experience advising organizations on compliance implications of digital health, AI, privacy, and data governance initiatives preferred
- CIPP, CHC, CHPC, or similar compliance/privacy certification preferred
Benefits:
- dental, vision, and multiple group medical plans to choose from
- a 401(k) retirement savings plan
- group life insurance
- accidental death and dismemberment (AD&D) insurance
- flexible spending account (FSA) and health savings account (HSA)
- commuter benefits
- employer-paid short-term (STD) and long-term disability (LTD) insurance
- additional supplemental insurance plans (spouse life insurance, legal insurance, an employee assistance program, home health testing kits, and a fertility medication discount program)
- flexible vacation time
- accrued paid sick time
- 10 paid holidays
- 2 floating holidays for full time non-exempt employees
- eight weeks of paid parental leave for eligible employees
- additional paid weeks for the birthing parent
- 4 weeks paid caregiver leave
- a Lifestyle Spending Account allowance each month
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