Director, Compliance and Audit

🔥 12 hours ago

🏈 Alabama, Arizona, +22 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🗽 New York – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $124.1k - $155.2k / year

⏰ Full Time

🔴 Lead

🚔 Compliance

👻 Ghost score 0%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Lead and evolve Navitus’ Healthcare Regulatory Adherence and Audit function • Oversee Compliance, Audit, and Accreditation programs and lead the Regulatory Adherence and Audit team, including the Accreditation team • Administer, manage performance, and continuously improve compliance, audit, and accreditation programs and enterprise-wide initiatives • Direct operational implementation, tracking, and validation of new or revised regulatory requirements • Ensure business units complete required actions, policy updates, training activities, and control enhancements • Develop, direct, and monitor compliance, internal audit, and accreditation work plans and audit and monitoring schedules • Establish accountability frameworks and monitoring processes • Lead compliance oversight for emerging regulatory risks, including artificial intelligence governance, accessibility, data governance, health equity, consumer protections, transparency, and evolving healthcare regulations • Conduct and direct compliance risk assessments, regulatory impact assessments, and implementation activities • Track, trend, and report internal quality metrics and oversee corrective action plans • Provide leadership for URAC PBM, NCQA Utilization Management, NCQA Health Information Product, and related accreditation programs • Maintain accreditation documentation and oversee desktop and on-site accreditation reviews and PBM re-accreditation readiness • Participate in accreditation workgroups and provide feedback to accrediting bodies • Ensure accurate reporting of mandatory accreditation measures and data validation requirements • Collaborate with accredited Health Plan partners to support readiness and accreditation survey outcomes • Direct training on quality management, utilization management, accreditation standards, and Section 508 compliance • Develop and manage the annual budget and monitor monthly financial performance

🎯 Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Compliance, Legal Studies, or a related field, or equivalent work experience, required • 7+ years of experience in compliance, audit, accreditation, regulatory affairs, quality management, healthcare operations, or a related regulatory environment required • 5+ years of progressive leadership experience required in a role responsible for administering a compliance program, accreditation program, audit function, or regulatory framework required • Knowledge and expertise in audits, healthcare claims operations, regulatory analysis, process improvement, reporting, and/or project management within a healthcare, PBM, or related regulated environment is required • Significant people leadership and team management experience • Healthcare compliance, audit, accreditation, or regulatory oversight experience • Experience interpreting regulations and overseeing implementation of new regulatory requirements • Strong operational audit experience within healthcare environments • Experience partnering with legal, compliance, and business stakeholders to execute strategic initiatives • Client-facing experience, including leading meetings with external stakeholders, auditors, regulators, or accreditation organizations • A track record of building programs, improving processes, and driving organizational accountability • Ability to consistently interact cooperatively and respectfully with other employees • Certification in Healthcare Compliance (CHC) or related certification preferred • MBA or Juris Doctorate preferred • URAC, NCQA, or other healthcare accreditation experience preferred

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750! • STAR Bonus % (At Risk Maximum): 15.00