Director, Compliance and Audit

This is a fully remote position, open to applicants in Alabama, +23 more states.

📋 Description

• Lead and enhance the Healthcare Regulatory Adherence and Audit function at Navitus.

• Supervise Compliance, Audit, and Accreditation programs while guiding the Regulatory Adherence and Audit team, which includes the Accreditation team.

• Manage performance, administer, and continuously enhance compliance, audit, and accreditation programs along with enterprise-wide initiatives.

• Oversee the operational implementation, monitoring, and validation of new or updated regulatory requirements.

• Ensure that business units fulfill necessary actions, update policies, conduct training activities, and enhance controls.

• Develop, direct, and oversee compliance, internal audit, and accreditation work plans along with audit and monitoring schedules.

• Create accountability frameworks and monitoring processes.

• Provide compliance oversight for emerging regulatory risks, which include 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.

• Monitor, trend, and report on internal quality metrics, as well as supervise corrective action plans.

• Offer leadership for URAC PBM, NCQA Utilization Management, NCQA Health Information Product, and related accreditation programs.

• Maintain accreditation documentation and manage both desktop and on-site accreditation reviews, as well as PBM re-accreditation readiness.

• Engage in accreditation workgroups and provide insights to accrediting bodies.

• Ensure precise reporting of mandatory accreditation measures and data validation requirements.

• Collaborate with accredited Health Plan partners to assist in readiness and accreditation survey outcomes.

• Lead training sessions on quality management, utilization management, accreditation standards, and Section 508 compliance.

• Develop and oversee the annual budget while monitoring monthly financial performance.

⛳️ Requirements

• A Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Compliance, Legal Studies, or a related field, or equivalent work experience, is required.

• A minimum of 7 years of experience in compliance, audit, accreditation, regulatory affairs, quality management, healthcare operations, or a related regulatory environment is required.

• At least 5 years of progressive leadership experience is required in a role responsible for managing 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 similarly regulated environment.

• Significant experience in people leadership and team management.

• Expertise in healthcare compliance, audit, accreditation, or regulatory oversight.

• Experience in interpreting regulations and supervising the implementation of new regulatory requirements.

• Strong operational audit experience within healthcare settings.

• Experience collaborating 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 proven track record of building programs, improving processes, and driving organizational accountability.

• Ability to consistently interact in a cooperative and respectful manner with colleagues.

• Certification in Healthcare Compliance (CHC) or a related certification is preferred.

• An MBA or Juris Doctorate is preferred.

• Experience with URAC, NCQA, or other healthcare accreditation is preferred.

🏝️ Benefits

• Comprehensive benefits package for Health, Dental, and Vision insurance.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% with 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.