Manager, Pharmacy Standards

Job Summary

The Manager, Pharmacy Standards is responsible for developing, implementing, and overseeing regulatory standards and supporting the compliance program for Stellus Rx. This role advises on the development and maintenance of pharmacy regulatory quality assurance, supports payer compliance initiatives, and provides oversight related to pharmacy licensure across all 50 states, including nonresident pharmacy requirements.

This position partners cross-functionally to provide guidance on safe dispensing practices, accurate claims submission, audit readiness, and continuity of multi-state pharmacy operations.

Accountabilities

Supports pharmacy compliance and regulatory standards by providing guidance, promoting risk mitigation, and partnering on audits, inspections, and continuous improvement.

Key Responsibilities

Pharmacy Compliance and Regulatory Standards

• Establish and maintain pharmacy policies, procedures, and standards aligned with federal and state regulations, accreditation requirements, and payer expectations.

• Interpret and apply federal and state pharmacy regulations, including State Board of Pharmacy and DEA requirements.
• Serve as a subject-matter expert on pharmacy regulatory compliance and standards of practice.

Payer Audits & Inspection Readiness

• Support readiness for third-party payer audits (PBM, Medicare Part D, Medicaid, commercial).
• Coordinate audit responses, documentation, and corrective action plans.
• Conduct internal audits and gap assessments to identify and mitigate compliance risk.
• Support regulatory inspections by State Boards of Pharmacy, DEA, and other agencies as applicable.

Training & Continuous Improvement

• Develop and deliver compliance and standards training for pharmacy staff.
• Communicate regulatory and payer updates in a clear, practical manner.
• Support quality and compliance improvement initiatives across pharmacy operations.

Multi-State Pharmacy Licensure

• Support pharmacy licensure and registrations in all 50 states, including resident and non-resident pharmacy licenses.
• Ensure operational standards align with state-specific licensure conditions and nonresident pharmacy requirements.
• Help coordinate license applications, renewals, changes, and correspondence with State Boards of Pharmacy.
• Maintain licensure tracking tools to ensure timely renewals and ongoing compliance.
• Support inspections, deficiencies, and corrective actions related to licensure.

Third-Party Payer Compliance & Claims Accuracy

• Interpret pharmacy-related provisions in third-party payer and PBM contracts, including Medicare Part D, Medicaid, and commercial plans.
• Translate payer requirements into operational standards and SOPs.
• Partner with finance and accounting teams to support accurate, compliant claim submission.

Controlled Substances Compliance

• Support controlled substance compliance programs, including DEA and state registrations, inventory controls, and diversion prevention.
• Assist with investigations and reporting related to theft or loss.

Qualifications

Required

• Active Pharmacist license in good standing (Texas required, or ability to obtain, and additional state licenses as required).
• 5+ years of pharmacy experience with exposure to retail and/or mail order pharmacy operations.
• Strong working knowledge of:
  • State Board of Pharmacy regulations (including nonresident licensure)
  • DEA controlled substance requirements
  • Third-party payer and PBM requirements
• Experience supporting audits, inspections, or compliance reviews.
• Strong writing, organizational, analytical, and communication skills.

Preferred

• Experience in pharmacy compliance, standards, licensure, audit, or quality roles.
• Experience managing or supporting pharmacy licensure across multiple states.
• Familiarity with URAC, NABP or other mail order/clinical pharmacy accreditation standards.
• Multi-state retail and/or mail order pharmacy experience.