Director, Compliance and Audit

Navitus Health Solutions, LLC•,

4d•$124,140 - $155,175•Remote

About The Position

Navitus is seeking a Director, Compliance & Audit to lead and evolve its Healthcare Regulatory Adherence and Audit function. This role involves overseeing the Compliance, Audit, and Accreditation programs to ensure the organization remains compliant, audit-ready, and positioned for success in the evolving healthcare landscape. The Director will lead a team responsible for internal and external audits, accreditation activities, regulatory implementation audits, and enterprise-wide compliance initiatives. This is not a financial audit role, but rather focuses on operational audits, healthcare compliance programs, accreditation standards, and regulatory implementation, ideally within regulated healthcare environments such as health plans, hospitals, PBMs, or TPAs.

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.
The ability to consistently interact cooperatively and respectfully with other employees.

Nice To Haves

MBA or Juris Doctorate preferred.
Certification in Healthcare Compliance (CHC) or related certification preferred.
URAC, NCQA, or other healthcare accreditation experience preferred.
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.
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.

Responsibilities

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.