Quality Manager
Navitus Health Solutions
full-time
Posted on:
Location Type: Remote
Location: Idaho • United States
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Salary
💰 $82,587 - $101,333 per year
About the role
- 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.
Requirements
- Bachelor’s degree in healthcare administration, pharmacy, nursing, quality management, or a related field, or equivalent work experience, required.
- Lean, Six Sigma, or quality improvement certification preferred.
- 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.
- Experience with call center quality monitoring platforms and audit tools preferred.
- Participate in, adhere to, and support compliance program objectives.
- The ability to consistently interact cooperatively and respectfully with other employees.
Benefits
- 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
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
quality monitoringoperational process auditsaudit governancesampling strategiesscoring frameworksrisk-based auditsroot cause analysisaudit toolsdata analysisperformance improvement
Soft Skills
leadershipcoachingmentoringcommunicationcollaborationproblem-solvingaccountabilitycontinuous improvementinterpersonal skillsadaptability
Certifications
Lean certificationSix Sigma certificationquality improvement certification