Manager, Compliance and SIU-Remote

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.  

We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

The Compliance and SIU Manager will assist the Associate Director, Corporate Compliance in the execution and maintenance of the operations of the Navitus Compliance and fraud, waste, and abuse (FWA) program, including controls, policies & procedures, communications and training. The Compliance and SIU Manager will work in a professional role with a high level of independence, to ensure reports of non-compliance and FWA are investigated, program elements are implemented, and controls are examined periodically for effectiveness and efficiency. The Compliance and SIU Manager will lead department investigators, analysts and serve in a back-up role to the Associate Director, Corporate Compliance. The role requires knowledge of compliance regulations, investigative processes, policy management, reporting data mining and claims review, and have general knowledge of pharmacy. The Compliance and SIU Manager shall be self-initiating for projects seeking supervisory guidance where appropriate. The Compliance and SIU Manager will receive direction and oversight of work from the Associate Director, Corporate Compliance.

Is this you? Find out more below! 

How do I make an impact on my team?  

• Exercise daily oversight of Compliance, HIPAA and FWA operations including workload, report quality, staff development, and presentation of information to clients or external authorities.
• Oversee internal department tools such as 3D data mining tools, Compass SIU database, corporate compliance hotlines
• Oversee trend development for Compliance, HIPAA and FWA including potential FWA fraud schemes, emerging privacy issues, and inquires for further investigation and development of preventive or corrective measures. 
• Identify and support implementation of improvements such as communication, monitoring, or enforcement of Compliance, HIPAA and FWA standards.
• Research and support response to investigative and corrective action plans and queries. 
• Evaluate, review and/or modify policies or operating guidelines to comply with changes to client requirements or regulations.
• Maintain records of Compliance, HIPAA and FWA activities, including any complaints or investigations 
• Validate and support trend detection for internal and external metrics for Compliance, HIPAA and FWA.
• Independently investigate cases of non-compliance with Compliance, HIPAA and FWA in accordance with the investigation protocols and procedures, including final analyses. 
• Serve as a confidential point of contact for employees to communicate with management, seek clarification on issues or dilemmas, or report irregularities.

What our team expects from you? 

• A minimum of a bachelor’s degree is required, preferably in criminal justice, risk management, healthcare and/or pharmacy preferred. 
• Certified Fraud Examiner or compliance certification is strongly desired. 
• Pharmacy Technician certification is preferred. 
• A combination of education and relevant work experience may substitute the education requirement. 
• A minimum of four (4) years’ experience in pharmacy and/or healthcare compliance, claims investigations and/or auditing is highly desired. 
• Knowledge of Medicare and Medicaid billing and third-party payer billing regulations and reimbursement is also highly desired.
• 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?

• Hours/Location: Monday-Friday 8:00am-5:00pm, CST-Remote
• Paid Volunteer Hours
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!
• Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program

#LI-Remote