Director of Product – Health Navigation and Wellbeing
Alight Solutions
Cloud
Delegation Audit Specialist
Capital Rx
full-time
Posted on:
Origin: • 🇺🇸 United States • New York
Visit company websiteSalary
💰 $60,000 - $90,000 per year
Job Level
Mid-LevelSenior
Tech Stack
Cloud
About the role
- Capital Rx: health technology company and PBM providing claim administration and cloud-native enterprise health platform Judi.
- Ensure Capital Rx meets contractual and regulatory obligations to health plan clients through delegation audits.
- Manage end-to-end audit lifecycle: intake, task assignments, timelines, document tracking, status updates, and final submission.
- Coordinate and draft responses aligned with CMS, URAC, NCQA, and state-level standards.
- Lead cross-functional audit response meetings and ensure stakeholder accountability.
- Maintain audit response trackers, document repositories, and response templates.
- Partner with Legal, Compliance, Operations, and Client Success to obtain materials, attestations, and policy documentation.
- Provide guidance to client-facing teams on delegation audit protocols and expectations.
- Implement centralized audit dashboard and develop risk scoring for delegation entities.
- Track response times and completion rates; monitor audit outcomes and client feedback to inform improvements.
- Align delegation audit activities with compliance monitoring including CAP tracking and risk assessments.
- Develop monthly and quarterly audit performance reports; contribute to audit readiness and internal mock audits.
- Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance.
Requirements
- Bachelor’s degree in a relevant discipline (e.g., Healthcare Administration, Business, Public Policy, or related field.)
- Minimum of three (3) years of experience in pharmacy benefit management, managed care, or health plan compliance.
- At least two (2) years of direct experience managing delegation audits, client audits, or accreditation reviews.
- Strong project management and organizational skills; proven ability to lead and coordinate cross-functional initiatives.
- Excellent verbal and written communication skills.
- Working knowledge of applicable regulatory and accreditation standards (e.g., CMS Part C/D, URAC, NCQA, and state Medicaid agencies).
- Proficiency in Microsoft Office tools.
- Preferred: Familiarity with audit tracking systems such as Jira or similar workflow management platforms.
- Preferred: Demonstrated understanding of PBM core functions including claims adjudication, prior authorization, pharmacy network management, and utilization management.
- Preferred: Experience collaborating with client-facing teams and managing sensitive client communications in high-stakes audit scenarios.
