Returning Candidate? Log back in! Med D Compliance Oversight Analyst Location US- ID 2025-4631 Category Administration Position Type Full-Time Remote Yes 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. Pay Range USD $58,460.00 - USD $70,434.00 /Yr. Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am-5pm, CT Overview

Navitus Health Solutions is seeking a Med D Compliance Oversight Analyst to join our team!

 

This position is an Med D Compliance Oversight Analyst  SME directly responsible for conducting internal and external audits and monitoring activities for the PBM Employer Group Waiver Program (EGWP) and MA-PD/MMP Health Plan audits. The Med D Compliance Oversight Analyst (COA) will conduct quality assurance review on all audit and monitoring results. The COA will be responsible for providing monthly/quarterly audit and monitoring reports to the internal audit review committee, the Medicare Part D Oversight Committee, and business partners/clients. The COA will coordinate Process Improvement/Remediation Plans as needed. The COA will be primarily responsible for interfacing with the Government Programs Regulatory Adherence and Auditing Manager to coordinate delivery of the monthly/quarterly oversight reports, as outlined in the Audit and Monitoring work plan for EGWP. This COA will also interface with various functional teams throughout Navitus. This role requires strong analytical and auditing skills, exceptional attention to detail, strong Excel skills and deep knowledge of Medicare Part D rules, regulations, and protocols.

 

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

Responsible for assisting internal teams with CMS guidance and protocolsDevelops, implements, and maintains an audit tracking and documentation systemIndependently performs internal audits per the EGWP/MAPD audit plan according to the DWI for specific audit: Creates audit PowerPoint presentation and audit workbook and Delivers audit report presentation to EGWP clientAssists internal departments (functional areas) in developing corrective actions/remediation as appropriate and monitors to ensure that corrective actions/remediation have been successfully implementedPerforms regulatory and client-initiated audits: Creates FA (Formulary Administration) and CDAG (Coverage Determinations Appeals and Grievances) universes and Prepares required audit deliverablesPrepares monthly CDAG (Coverage Determinations Appeals and Grievances) universes for designated client(s)Develops knowledge of what is a non-compliance event per CMS guidance and guidelines and has ability to distinguish what requires client notificationCreates client documentation to report a non-compliant event per the established processOther duties as assigned Qualifications

What our team expects from you?

A Bachelor’s Degree and/or three years of relevant experience3+ years’ experience and expertise in audits, facilitating process improvement, reporting, and/or operational monitoringExperience and expertise in Medicare Part D highly preferredExperience with Microsoft Excel and Office Suite products is strongly preferredParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employeesWhat can you expect from Navitus?       • Top of the industry benefits for Health, Dental, and Vision insurance      • 20 days paid time off      • 4 weeks paid parental leave      • 9 paid holidays      • 401K company match of up to 5% - No vesting requirement      • Adoption Assistance Program      • Flexible Spending Account   #LI-Remote

 

Location : Address Remote Location : Country US Options ApplyApplySubmit a ReferralRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Application FAQs

Software Powered by iCIMS
www.icims.com