Program & Compliance Manager, Pharmacy - Outpatient - Health Care District : Job Details

Job Description The 340B Program and Compliance Manager is responsible for planning, implementing, supporting, and overseeing all aspects of the 340B Program and pharmacy compliance functions, under the direction of the Corporate Director of Pharmacy Services or AVP, across all Health Care District of Palm Beach County pharmacy locations, including hospital (Lakeside Medical Center or LMC ) and Community Health Center ( CHC ) pharmacies. This role ensures full compliance with the Health Resources and Services Administration's ( HRSA ) Office of Pharmacy Affairs ( OPA ), Florida Board of Pharmacy, The Joint Commission (TJC), third-party payors, and applicable federal and state regulations. The Manager serves as the subject matter expert and liaison for 340B program operations, Pharmacy Benefit Manager ( PBM ) audit response, quality assurance, and compliance-related policies and procedures, internal and external auditing and monitoring, training and education, and investigations. This role includes oversight of split-billing software and data management, revenue cycle, purchasing/procurement and inventory management, provider enrollment/credentialing, and continuous performance improvement initiatives in support of the organization's strategic and operational goals. Additionally, the Manager evaluates contract pharmacy performance and explores new opportunities to maximize 340B program benefits while maintaining compliance and supporting the overall goals of the pharmacy program. The position also serves as project lead for pharmacy and related business, finance, and compliance initiatives, as assigned. This position ensures alignment between pharmacy operations and enterprise-wide compliance initiatives, promoting best practices in clinical care, data privacy, and regulatory adherence; As such, this role reports directly to the Corporate Director of Pharmacy Services or AVP, with a dotted-line relationship to the VP/Chief Compliance, Privacy & Ethics Officer. Relocation Assistance Provided Essential Functions:

• Manage day-to-day operations of 340B programs for in-house and contract pharmacies.
• Ensure compliance with HRSA/OPA, maintain records, and maintain a constant state of audit readiness.
• Conduct and document monthly/annual internal and contract pharmacy audits.
• Oversee 340B drug purchasing, inventory management, software (third party administrator (TPA)/split-billing), and utilization.
• Ensure prevention of duplicate discounts and diversion.
• Register new covered entity sites and monitor covered patient eligibility compliance.
• Analyze 340B utilization and identify opportunities to optimize savings and services, while maintaining compliance.
• Coordinate with vendors, wholesalers, and TPAs to ensure software and interface accuracy.
• Compliance, Quality, and Revenue Cycle Management.
• Develop, implement, and oversee a comprehensive Pharmacy Compliance Program. Act as a liaison between operational and compliance teams, facilitating policy developments, auditing and monitoring, training and education, and ensuring responsiveness to issues, inquiries and investigations. Provides routine updates to VP/CCO on compliance matters.
• Demonstrated knowledge of applicable federal and state rules and regulations governing this area (e.g., DEA, CMS, HRSA, Florida Board of Pharmacy, NABP and USP797). Monitors and communicate regulatory changes and update compliance protocols accordingly.
• Respond to PBM audits and manage PBM credentialing and contracting for pharmacies.
• Conduct independent investigations and maintain documentation of compliance activities, in conjunction with Compliance.
• Implement policies and procedures and monitor for adverse events, medication incidents, and quality reviews.
• Coordinate quarterly audits for trends, root cause analysis, and corrective action.
• Serve as the primary contact for FDA 503b notices and USP guidance.
• Provide education on pharmacy compliance topics and 340B best practices to staff.
• Maintain up-to-date training documentation and competency assessments.
• Collaborate with internal departments (e.g., Legal, Human Resources, IT, Compliance, Finance, Revenue Cycle, Purchasing).
• Communicate effectively with external auditors and regulatory agencies for audits and investigations.
• Provide periodic reports on compliance, quality metrics, and 340B performance; including, but not limited to cost savings and operational efficiencies.
• Support strategic initiatives to enhance patient outcomes and cost-efficiency.
• Promote teamwork and foster a culture of accountability, quality, and compliance.
• Assist with HR-related responsibilities including staff evaluation and mentoring.
• Perform or assist in other compliance or internal audits, as assigned.

QualificationsEducation:

• High School Diploma or GED required.
• Associates degree, bachelor's or master's degree in a health or business-related field preferred.

Experience:

• Minimum of 5 years of experience as a Pharmacy Technician in hospital/retail settings.
• Experience managing 340B programs and compliance initiatives for retail, Federally Qualified Health Centers (FQHCs) or Disproportionate Share Hospitals (DSH).
• Experience with compliance programs, internal audits, and/or investigations related to pharmacy services is preferred.

Certification:

• Apexus Certified Operations Expert preferred or must complete within 6 months of hire or transfer into this position.
• Health Care Compliance Certification (Certified in Healthcare Compliance, CHC) is preferred or must complete within 1 year of hire or transfer into this position or as soon as requirements are met to sit for the examination. Certified Compliance and Ethics Professional (CCEP) is also preferred and may be considered in lieu of CHC.

Licensure:

• Current and unrestricted Pharmacy Technician license in the state of Florida is preferred.

About Us The Health Care District of Palm Beach County is an independent special taxing district that has served as a healthcare safety net for more than 36 years to fill in gaps in access to healthcare services. This unique healthcare system covers the entire county and provides a wide range of services such as nine community health centers (Federally Qualified Health Centers) which serve everyone regardless of ability to pay; school health teams in 172 public schools; a lifesaving Trauma Hawk aeromedical helicopter program; a rural, public teaching hospital, Lakeside Medical Center; an award-winning skilled nursing center; a ground ambulance program for Health Care District patients needing a higher level of care and the county's Trauma Agency, which ensures quality outcomes within the county's trauma system and leads initiatives to prevent traumatic injury. We are committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, veteran or military status, genetic information, sexual orientation, marital status, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. The information collected by this application is solely to determine suitability for employment, verify identity and maintain employment statistics on applicants. We are also committed to maintaining a safe, healthy, and productive work environment for all employees. As such, we are a Drug-Free Workplace.