Consultant, Accreditation Compliance

Navitus Health Solutions / Lumicera Health Services

United States

Remote

USD 72,000 - 86,000

Full time

14 days+

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Benefits offered by this job

Health, dental, and vision insurance

Paid time off: 20 days

Parental leave: 4 weeks

9 paid holidays

401K company match up to 5%

Adoption assistance

Flexible spending account

Educational + professional membership

Job summary

Navitus Health Solutions is seeking a Consultant, Accreditation Compliance to join our team. The Consultant supports accreditation readiness, quality management, and compliance across Navitus, serving as a subject matter expert on standards and processes.

The role partners across the organization to drive readiness and outcomes. Responsibilities include audits, training, and liaison activities with accreditation bodies; the candidate will guide, educate, and advise associates, leaders, clients,

Qualifications

Bachelor’s degree required in Healthcare Administration, Quality Management, Business Administration, Public Health, Pharmacy, or a related field, or equivalent work experience, required.
5+ years of experience in accreditation, compliance, quality management, or a related field required.
Experience with accreditation programs such as URAC, NCQA, or similar accreditation organizations required.
Experience interpreting and applying accreditation standards and leading accreditation readiness, survey preparation, audit, or compliance activities required.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

Serve as a subject matter expert on accreditation standards, requirements, and interpretations; provide consultation, guidance, and training to associates, leaders, clients, consultants, and other stakeholders regarding accreditation expectations, compliance requirements, and best practices.
Evaluate organizational practices, processes, and controls against applicable accreditation standards and identify opportunities to strengthen compliance, quality outcomes, and operational effectiveness.
Serve as the primary liaison with accreditation organizations, consultants, and external stakeholders as appropriate, communicating accreditation updates, regulatory changes, and compliance requirements to support organizational readiness and ongoing compliance.
Manage the Navitus Quality Management Program, including facilitating quarterly meetings, maintaining program documentation, and collaborating with departments to monitor performance metrics associated with applicable accreditation standards (e.g. URAC PBM, NCQA, etc.).
Perform accreditation audits and assessments to evaluate compliance with applicable standards, identify performance gaps, and recommend corrective actions.
Evaluate and enhance audit methodologies, quality processes, and performance measurement tools to improve operational efficiency, accreditation readiness, and organizational outcomes.
Lead root cause analysis activities and partner with stakeholders to develop, implement, and monitor corrective action plans that address compliance risks and improve organizational performance.
Collect and analyze quantitative and qualitative data, identify trends, risks, and opportunities, and provide recommendations that support continuous improvement and accreditation readiness.
Develop, maintain, and continually improve documentation, strategies, processes, and objectives required to achieve and maintain accreditation and support client accreditation activities.
Provide information, consultation, and training on accreditation standards, quality management practices, and industry best practices to associates, clients, and other stakeholders.
Lead all aspects of accreditation surveys and reviews, including preparation, coordination, facilitation, communication, and follow-up activities necessary to maintain accreditation.
Participate in client meetings and accreditation activities, representing Navitus’ accreditation position and providing consultative support related to accreditation standards and compliance requirements.
Develop and maintain client specific delegation agreements in collaboration with current and future accredited health plan clients.
Other duties as assigned.

Skills

Accreditation knowledge

Quality management

Consultation and training

Stakeholder communication

Education

Bachelor’s degree or equivalent in Healthcare Administration, Quality Management, Business Administration, Public Health, Pharmacy, or related field

5+ years of experience in accreditation, compliance, quality management, or related field

Job description

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 $71,716.00 - USD $86,405.00 /Yr.

STAR Bonus % (At Risk Maximum)

7.50 - Salaried Non-Management except pharmacists

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm

Remote Work Notification

ATTENTION: Lighthouse is only able to offer remote work to residents of Alabama, Arizona, California, Colorado, Connecticut, Dist. of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, Oregon, Pennsylvania, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin.

Overview

Navitus Health Solutions is seeking a Consultant, Accreditation Compliance to join our team!

The Consultant, Accreditation Compliance is a key member of the Accreditation Quality Team and is responsible for supporting and maintaining accreditation programs across Navitus. This role ensures compliance with accreditation standards delegated to or supported by Navitus Health Solutions through oversight of reporting, analysis, audits, validation activities, and continuous quality improvement initiatives. This role serves as a subject matter expert on accreditation standards and processes and provides consultation, guidance, and education to associates, leaders, clients, and other stakeholders. The Consultant partners across the organization to support accreditation readiness, quality management activities, delegation oversight, performance improvement initiatives, and successful accreditation outcomes.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

Serve as a subject matter expert on accreditation standards, requirements, and interpretations; provide consultation, guidance, and training to associates, leaders, clients, consultants, and other stakeholders regarding accreditation expectations, compliance requirements, and best practices.
Evaluate organizational practices, processes, and controls against applicable accreditation standards and identify opportunities to strengthen compliance, quality outcomes, and operational effectiveness.
Serve as the primary liaison with accreditation organizations, consultants, and external stakeholders as appropriate, communicating accreditation updates, regulatory changes, and compliance requirements to support organizational readiness and ongoing compliance.
Manage the Navitus Quality Management Program, including facilitating quarterly meetings, maintaining program documentation, and collaborating with departments to monitor performance metrics associated with applicable accreditation standards (e.g. URAC PBM, NCQA, etc.).
Perform accreditation audits and assessments to evaluate compliance with applicable standards, identify performance gaps, and recommend corrective actions.
Evaluate and enhance audit methodologies, quality processes, and performance measurement tools to improve operational efficiency, accreditation readiness, and organizational outcomes.
Lead root cause analysis activities and partner with stakeholders to develop, implement, and monitor corrective action plans that address compliance risks and improve organizational performance.
Collect and analyze quantitative and qualitative data, identify trends, risks, and opportunities, and provide recommendations that support continuous improvement and accreditation readiness.
Develop, maintain, and continually improve documentation, strategies, processes, and objectives required to achieve and maintain accreditation and support client accreditation activities.
Provide information, consultation, and training on accreditation standards, quality management practices, and industry best practices to associates, clients, and other stakeholders.
Lead all aspects of accreditation surveys and reviews, including preparation, coordination, facilitation, communication, and follow-up activities necessary to maintain accreditation.
Participate in client meetings and accreditation activities, representing Navitus’ accreditation position and providing consultative support related to accreditation standards and compliance requirements.
Develop and maintain client specific delegation agreements in collaboration with current and future accredited health plan clients.
Other duties as assigned.

Qualifications

Whatourteamexpectsfrom you?

Bachelor’s degree required in Healthcare Administration, Quality Management, Business Administration, Public Health, Pharmacy, or a related field, or equivalent work experience, required.
5+ years of experience in accreditation, compliance, quality management, or a related field required.
Experience with accreditation programs such as URAC, NCQA, or similar accreditation organizations required.
Experience interpreting and applying accreditation standards and leading accreditation readiness, survey preparation, audit, or compliance activities required.
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?