Licensing & Audit Specialist (Pharmacy Compliance & Regulatory)

Description

About Us

At Gifthealth, we're revolutionizing the way people experience healthcare by simplifying the process of managing prescriptions and health services. Our mission is to provide a seamless, personalized, and efficient healthcare experience for all our customers. We're a dynamic, innovative, and customer-centric company dedicated to making a positive impact on people's lives.

Position Summary

The Licensing & Audit Specialist will own all aspects of pharmacy licensing, PBM audit readiness, and regulatory compliance tied to facility operations and ownership structure across all Gifthealth locations.

This role is highly specialized and operational, focusing on maintaining active licenses, managing audits, ensuring compliance with PBM and payer requirements, and overseeing regulatory filings related to corporate structure (ownership, PE relationships, and pharmacy hierarchy).

This individual will serve as the single point of accountability for ensuring every Gifthealth facility remains compliant, audit-ready, and properly credentialed at all times.

Key Responsibilities

Licensing & Credentialing

• Manage all state pharmacy licenses, non-resident licenses, and facility permits across all operating states
• Maintain DEA registrations, controlled substance licenses, and related regulatory filings
• Oversee timely renewals, applications, and expansions into new states
• Ensure all facilities meet state board of pharmacy requirements at all times
  
  

PBM & Insurance Compliance

• Maintain compliance with PBM (Pharmacy Benefit Manager) requirements, including credentialing and recredentialing
• Ensure alignment with payer contracts, pharmacy network participation rules, and audit standards
• Monitor and implement updates related to Medicare, Medicaid, and commercial payer policies
  
  

Audit Ownership (Core Function)

• Serve as the primary owner of all PBM, payer, and regulatory audits
• Prepare documentation, respond to audit requests, and track findings through resolution
• Develop and maintain audit readiness programs, ensuring documentation is always up to date
• Partner with internal teams to correct deficiencies and prevent repeat findings
  
  

Facility & Organizational Compliance

• Maintain accurate documentation of ownership structure, including:
• Parent entities
• Private equity relationships
• PIC (Pharmacist-in-Charge) assignments
• Corporate hierarchy and control structures
• Ensure all filings reflect current organizational structure and ownership disclosures
• Support regulatory reporting tied to change of ownership (CHOW), facility updates, or expansions
  

Documentation & Reporting

• Maintain centralized records for:
• Licenses
• Audit results
• PBM requirements
• Regulatory filings
• Provide regular reporting to leadership on:
• License status across all states
• Audit outcomes and risk areas
• Upcoming regulatory deadlines
  

Qualifications

• Proven experience in pharmacy licensing, PBM compliance, or regulatory audits
• Strong understanding of:
• State Board of Pharmacy regulations
• PBM audit processes
• Pharmacy credentialing and payer requirements
• Experience managing multi-state licensing and facility compliance
• Familiarity with corporate ownership structures, PE-backed healthcare organizations, and regulatory disclosures
• Highly detail-oriented with strong organizational and documentation skills
• Ability to manage multiple audits, deadlines, and regulatory requirements simultaneously
• Excellent communication skills, especially in responding to auditors and regulatory bodies
• Bachelor’s degree in healthcare administration, business, compliance, or related field preferred
  
  

Work Environment

• Location: Hybrid / Remote
• Schedule: Full-time
• May require availability during [specific hours or days] or flexibility for escalations.
• Regular meetings with [teams, departments, or leadership] to ensure alignment.
  
  

Key Essential Functions

• Must be able to remain in a stationary position (sitting or standing) for extended periods, up to 4 hours at a time, while working.
• Must be able to occasionally lift up to 15 pounds (e.g., files, office equipment).
• Must be able to perform repetitive motions for an entire shift, including typing, reaching, and handling documentation.
• Must be able to work onsite for all scheduled shifts.
  
  

Employment Classification

Status: Full-time

FLSA: Exempt

Equal Employment Opportunity (EEO) Statement

Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status.

We celebrate diversity and are committed to creating an inclusive environment for all employees. If you do not meet every requirement but still feel you would be a great fit for this role, we encourage you to apply!

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time.

Salary Description

$75,000-$95,000