Description:
Reporting to the Chief Legal Officer with a dotted line to the SVP, Government Programs, the Government Programs Compliance Officer plays a critical role in ensuring LucyRx’s adherence to all applicable federal and state regulations governing government-sponsored healthcare programs, including Medicare, Medicaid, and other public health initiatives. This position is responsible for developing, implementing, and monitoring compliance programs, policies, and procedures to mitigate risk and ensure regulatory alignment. The officer collaborates cross-functionally with legal, operations, clinical, and audit teams to oversee internal controls, conduct compliance training, manage audits, and respond to regulatory inquiries. The ideal candidate possesses deep knowledge of CMS regulations, strong analytical skills, and a proactive approach to maintaining a culture of compliance.

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting which involves utilizing a computer, mouse, keyboard, and occasionally operates other standard office equipment, such as printer, copier, phone. Travel may be required by either car or airplane, or a combination of multiple modes of transportation.
LucyRx is an independent, next-generation pharmacy benefit manager (PBM) redefining prescription care. Fueled by innovation and decades of leadership experience, LucyRx delivers better outcomes through its integrated specialty network, formulary marketplace, and next-day home delivery solutions.
Powered by its proprietary AI platform, LucyIQ™, the company provides real-time insights that support evidence-based clinical decisions, clear pricing, and exceptional service from U.S.-based pharmacy technicians. Partnering with more than 60,000 pharmacies, LucyRx serves over 1,200 clients nationwide.
We offer competitive pay and benefits, and are open to discussing compensation that reflects the value you bring to our team

Requirements:

• Bachelor’s degree in healthcare administration, business, law, or a related field (Master’s or JD preferred).
• 7+ years of experience in healthcare compliance, preferably within a PBM or managed care organization.
• In-depth knowledge of Medicare Part D, Medicaid Managed Care, and CMS compliance requirements.
• Strong understanding of healthcare laws and regulations, including HIPAA, ACA, and FWA statutes.
• Experience with audit processes, regulatory reporting, and risk management.
• Excellent analytical, organizational, and communication skills.
• Certified in Healthcare Compliance (CHC) or similar credential

• Develop, implement, and maintain compliance policies and procedures for government programs in accordance with CMS, state Medicaid agencies, and other regulatory bodies.
• Monitor regulatory changes and assess their impact on LucyRx operations; ensure timely updates to internal policies and training materials.
• Lead internal audits and readiness assessments; coordinate external audits and regulatory reviews.
• Investigate and resolve compliance issues, including potential fraud, waste, and abuse (FWA) concerns.
• Collaborate with legal, operations, clinical, and IT teams to ensure compliance is embedded in business processes.
• Oversee the development and delivery of compliance training programs for employees and contractors.
• Maintain documentation and reporting systems to track compliance activities, findings, and corrective actions.
• Serve as a liaison with regulatory agencies and industry groups on compliance matters.
• Support the development and execution of the LucyRx’s Compliance Program and Annual Compliance Work Plan.

Requirements:

• Bachelor’s degree in healthcare administration, business, law, or a related field (Master’s or JD preferred).
• 7+ years of experience in healthcare compliance, preferably within a PBM or managed care organization.
• In-depth knowledge of Medicare Part D, Medicaid Managed Care, and CMS compliance requirements.
• Strong understanding of healthcare laws and regulations, including HIPAA, ACA, and FWA statutes.
• Experience with audit processes, regulatory reporting, and risk management.
• Excellent analytical, organizational, and communication skills.
• Certified in Healthcare Compliance (CHC) or similar credential.