Manager, Quality

Navitus Health Solutions, LLC

4d•$82,587 - $101,333•Remote

About The Position

Due to growth, we are adding a Manager, Quality to our team. The Manager, Quality leads the specialty pharmacy’s Internal Quality & Audit Program, providing oversight of telephonic quality monitoring and operational process audits to ensure adherence to organizational standards, regulatory requirements, and accreditation expectations. This role is responsible for maintaining a high-reliability quality framework that evaluates patient interactions, workflow integrity, and documentation practices to safeguard patient safety, compliance, and service excellence. Through data analysis, risk-based auditing, and cross-functional collaboration, the Manager identifies performance trends, control gaps, and systemic risks, translating findings into actionable insights and continuous improvement initiatives that directly support positive patient safety outcomes. This position plays a critical role in strengthening regulatory readiness, informing risk management strategies, and supporting scalable growth as the organization expands health system partnerships and specialty pharmacy services.

Requirements

Bachelor’s degree in healthcare administration, pharmacy, nursing, quality management, or a related field, or equivalent work experience, required.
5+ years of progressive experience in healthcare quality, auditing, compliance, or specialty pharmacy operations required.
3+ years of experience in coaching, mentoring, and/or leading others required.
Demonstrated experience developing or managing quality audit programs required.
Experience with specialty pharmacy accreditation standards (e.g., URAC, ACHC, or similar) required.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Nice To Haves

Lean, Six Sigma, or quality improvement certification preferred.
Experience with call center quality monitoring platforms and audit tools preferred.

Responsibilities

Lead and continuously mature the organization’s Internal Quality & Audit Program, encompassing telephonic quality monitoring and operational process audits.
Establish audit governance, methodologies, sampling strategies, scoring frameworks, and reporting standards across all audit activities.
Ensure audit activities align with regulatory requirements, accreditation standards, and organizational risk priorities.
Promote a culture of quality, accountability, and continuous improvement that prioritizes patient safety and harm prevention.
Oversee the established call quality auditing program, including supervision of the Pharmacy Quality Supervisor and audit team.
Ensure consistent scoring, calibration, and inter-rater reliability across call evaluations.
Validate adherence to communication standards, patient education requirements, scripting, and compliance protocols.
Monitor for and address communication breakdowns that could contribute to medication errors, delayed therapy or patient harm.
Partner with call center leadership to translate audit findings into coaching strategies, training initiatives, and performance improvement plans.
Monitor program effectiveness and implement enhancements to improve scoring accuracy, efficiency, and operational impact.
Support implementation, management, and effective utilization of quality management systems.
Conduct risk-based audits to evaluate process integrity, documentation accuracy, and adherence to policies and standards.
Identify process vulnerabilities that could lead to medication errors, therapy delays, privacy breaches, or other patient safety risks.
Develop and maintain audit tools, checklists, and protocols to ensure consistency and scalability.
Design, implement, and maintain a comprehensive internal audit framework for specialty pharmacy workflows, including patient intake and benefits investigation; clinical review and documentation; prior authorization and payer requirements; dispensing, verification, fulfillment, and inventory processes; patient onboarding, counseling, and adherence programs; and accreditation compliance.
Analyze audit findings to identify trends, systemic risks, performance gaps, and improvement opportunities.
Develop dashboards and reports that translate audit data into actionable insights for leadership and operational teams.
Lead root cause analysis and partner with stakeholders to implement corrective and preventive action plans (CAPAs).
Monitor effectiveness of improvement initiatives and adjust audit focus based on outcomes.
Provide audit insights to Risk Management and Compliance teams to support proactive risk identification and mitigation.
Identify control gaps in new or evolving workflows and recommend safeguards.
Escalate high-risk findings and track resolution to completion.
Establish policies, procedures, and documentation standards for audit activities.
Travel up to 25-50% to pharmacy sites, with occasional travel to conferences.
Other duties as assigned.