Director, Compliance and Audit

Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap. Pay Range USD $124,140.00 - USD $155,175.00 /Yr. STAR Bonus % (At Risk Maximum) 15.00 - Director, GM of GP, PIC Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8-5PM Remote Work Notification ATTENTION: Lighthouse is unable to offer remote work to residents of Alaska, Delaware, Hawaii, Idaho, Iowa, Louisiana, Maine, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Rode Island, South Carolina, South Dakota, Vermont, West Virginia, and Wyoming. Overview Lead the Future of Healthcare Compliance, Audit, and Accreditation (not financial audit) Due to continued growth, Navitus is seeking a Director, Compliance & Audit to lead and evolve our Healthcare Regulatory Adherence and Audit function. This is an exciting opportunity for a seasoned healthcare compliance leader who thrives at the intersection of regulatory oversight, operational auditing, accreditation, risk management, and organizational change. In this high-impact leadership role, you will oversee the Compliance, Audit, and Accreditation programs, ensuring our organization remains compliant, audit-ready, and positioned for long-term success in a rapidly evolving healthcare landscape. You will lead a team responsible for internal and external audits, accreditation activities, regulatory implementation audits, and enterprise-wide compliance initiatives. This is not a traditional financial audit role. We are seeking a leader with experience in operational audits, healthcare compliance programs, accreditation standards, and regulatory implementation, ideally within health plans, hospitals, integrated delivery systems, PBMs, TPAs, healthcare services organizations, or other highly regulated healthcare environments. The Director, Compliance and Audit leads the Regulatory Adherence and Audit team, including the Accreditation team, and is responsible for the overall administration, performance, and continuous improvement of Navitus’ Compliance, Audit, and Accreditation programs, as well as related enterprise-wide initiatives. This includes oversight of internal audits, external audits, accreditation activities, and regulatory implementation audits. What We're Looking For We are interested in leaders who bring: 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 Highly Desired Experience We strongly encourage candidates with experience in any of the following areas to apply: URAC accreditation NCQA accreditation and delegation oversight SOC audits (SOC 1, SOC 2, or related audit programs) Healthcare operational audits Regulatory compliance programs Managed care, health plans, hospitals, integrated health systems, PBMs, healthcare technology, or healthcare services organizations While PBM experience is valuable, candidates from broader healthcare environments, including provider, hospital, and health plan settings, are encouraged to apply given the breadth of regulatory and accreditation experience often gained in those organizations. Is this you? Find out more below! Responsibilities How do I make an impact on my team? Direct and lead the operational implementation, tracking, and validation of new or revised regulatory requirements, ensuring business units complete required actions, policy updates, training activities, and control enhancements. Develop, direct, and monitor compliance, internal audit and accreditation effectiveness, work plans and audit and monitoring schedules across all applicable business entities, operational functions, and lines of business Establish accountability frameworks and monitoring processes to ensure compliance and accreditation requirements are consistently implemented and sustained throughout the organization. Lead compliance oversight activities associated with emerging regulatory risk areas, including artificial intelligence governance, accessibility requirements, data governance, health equity initiatives, consumer protections, transparency regulations, and evolving healthcare regulations. Assess potential areas of compliance vulnerability through regular internal and external compliance risk assessments, including identification and mitigation of top organizational risks. Coordinate and lead enterprise compliance risk assessments and monitoring activities across business entities to identify emerging risks, overlapping regulatory obligations, and opportunities for risk mitigation. Conduct and direct regulatory impact assessments and implementation activities necessary to support new compliance requirements. Direct the tracking, trending, and reporting of internal quality metrics and ensure corrective action plans are developed and implemented when performance targets are not met. Provide leadership and oversight for accreditation programs including URAC PBM, NCQA Utilization Management (UM), NCQA Health Information Product (HIP), and related accreditation standards applicable to Navitus and its clients. Keep abreast of client accreditation standards to support clients with needed reporting, etc. This will include Health Plan, Health Equity, Managed Behavioral Health and Mental Health Parity or accreditation from other authorities. Develop and maintain policies and procedures that support compliance, audit, quality and accreditation standards; collaborate with departments to ensure timely updates and compliance. Oversee PBM re-accreditation applications and readiness, maintain documentation, and oversee both desktop and on-site accreditation review processes. Actively participate in accreditation or related workgroups to understand and implement new or updated standards and provide feedback to accrediting bodies. Partner with internal teams to ensure timely and accurate reporting of mandatory accreditation measures and data validation requirements. Collaborate with accredited Health Plan partners to support readiness activities and ensure successful accreditation survey outcomes. Direct training related to quality management, utilization management, accreditation standards, and Section 508 compliance for new and existing associates. Develop and manage the annual budget and monitor monthly financial performance. Qualifications What our team expects from you? Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Compliance, Legal Studies, or a related field, or equivalent work experience, required. MBA or Juris Doctorate preferred. Certification in Healthcare Compliance (CHC) or related certification preferred. 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. URAC, NCQA, or other healthcare accreditation experience preferred. Participate in, adhere to, and support compliance program objectives. The ability to consistently interact cooperatively and respectfully with other employees. What can you expect from Navitus? 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! #LI-Remote Location : Address Remote Location : Country US