Director, Compliance Programs

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Summary:

Capital Rx is seeking a seasoned compliance leader with a strong healthcare background, preferably in a pharmacy benefit management (PBM) setting, to drive the effectiveness of our compliance programs. The ideal candidate has direct experience managing teams, implementing compliance frameworks, and ensuring adherence to healthcare regulations at a fast-growing, highly regulated organization. This role requires someone who excels at both strategic oversight and hands-on execution in a complex, evolving regulatory landscape.

Position Responsibilities:

• Lead and scale compliance programs to ensure adherence to federal, state, and industry-specific regulations governing PBMs, payers, and healthcare organizations.
• Manage and mentor a team of compliance professionals, fostering growth, accountability, and operational excellence.
• Identify and drive process improvements to enhance compliance effectiveness, leveraging data-driven insights to optimize policies, monitoring, and reporting.
• Develop and maintain policies and procedures that align with regulatory expectations, industry best practices, and Capital Rx's mission.
• Collaborate cross-functionally with legal, operations, IT security, provider, clinical, and account management teams to embed compliance into business practices.
• Oversee regulatory assessments, audits, and risk evaluations, ensuring timely remediation and ongoing program enhancement.
• Lead compliance training and awareness efforts to ensure employees at all levels understand their compliance obligations.
• Ensure timely investigations and corrective actions are documented and implemented.
• Monitor, track, and report on compliance program performance, providing senior leadership with meaningful insights and recommendations.
• Uphold and enforce Capital Rx's Code of Conduct, ensuring a culture of integrity and accountability.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

Minimum Qualifications:

• Bachelor's degree in healthcare administration, pharmacy, law, business or a related field.
• 5+ years of compliance experience in a healthcare organization, preferably in PBM, payer, health plan or managed care settings.
• Certification in Healthcare Compliance (CHC) or similar certification.
• Proven leadership experience managing and developing teams.
• Stong knowledge of healthcare regulations (e.g., CMS, OIG, HIPAA, state PBM laws)
• Demonstrated success in change management and process improvement, with a track record of implementing scalable compliance frameworks.
• Exceptional communication, analytical, and stakeholder management skills.

Preferred Qualifications:

• Doctor of Pharmacy or J.D.
• Experience with Lean Six Sigma or other process improvement methodologies.

Base Salary: $140,000 - $160,000

Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.

Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi, the company's cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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