Delegation Oversight Audit Manager

Job not on LinkedIn

November 20

Apply Now

Receive Emails with Similar Jobs

Capital Rx

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Fintech • Artificial Intelligence

Capital Rx is the fastest growing healthtech company in America, dedicated to transforming the prescription pricing and patient care landscape. Founded in 2017, it offers innovative pharmacy benefit management (PBM) services, including customizable pharmacy benefits for large employers and an AI-powered care navigation platform. Capital Rx focuses on delivering cost-effective solutions and operational efficiencies to clients while ensuring transparency and quality care for patients.

501 - 1000 employees

Founded 2017

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

📋 Description

• Oversee daily compliance operations, including issue tracking, policy management, and regulatory reporting. • Supervise and mentor compliance staff, ensuring timely task execution and professional growth. • Manage new client compliance requests with accuracy and efficiency. • Collaborate with internal teams to ensure compliance with federal and state regulations (e.g., CMS, HIPAA, ERISA, TPA). • Maintain and enhance dashboards, metrics, and reporting tools. • Develop and implement training, policies, and procedures. • Coordinate internal audits and support external audit readiness. • Lead URAC and NCQA accreditation efforts. • Identify and implement process improvement initiatives. • Serve as compliance liaison for new hire orientation and internal communications (e.g., surveys, Compliance Week activities). • Maintain positive and collaborative working relationships with internal business partners. • Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.

🎯 Requirements

• Bachelor’s degree required • Master’s degree in public health, Healthcare Administration, Business, or related field preferred. • Minimum 5 years of experience in compliance, risk management, or regulatory affairs, preferably in healthcare or pharmacy benefit management. • Compliance certification required (e.g., CHC, CCEP, CRCMP). • Demonstrated experience managing or mentoring staff. • Experience with NAVEX platforms is strongly preferred. • Working knowledge of URAC and NCQA accreditation standards required. • Strong project management, analytical, and communication skills. • Proficiency with Microsoft Office Suite and compliance management systems.