Nancy Waltermire is an associate director in the Healthcare and Life Sciences Disputes, Regulatory, Compliance & Investigations practice at Navigant. Nancy is a seasoned professional with proven ability to manage multi-functional areas of operations and maintain compliance with Federal & State Regulations. Successful in the implementation and administration of government contracts. Nancy provides consulting and expert services relating to regulatory compliance and operations in the commercial and government-sponsored programs space. Her experience includes working with payers (commercial, Medicare Advantage and Part D, SNP MOC, Medicaid, & Affordable Care Act) providers (ancillary providers and pharmacies) and pharmaceutical manufacturers. Nancy has performed numerous risk assessments, HIPAA Privacy & Security Risk Assessments, compliance and delegation oversight program implementations and effectiveness measurement assessments, including Independent Validation Audits of Health Plans for Part C ODAG, CPE & SNP MOC.
Additionally, Nancy has conducted data analyses for many large payers, providers, and Pharmacy Benefit Managers (“PBMs”) by examining many different enrollment, clinical, and medical and pharmacy claims systems. In her work, Ms. Waltermire is frequently retained to conduct government program risk assessments, compliance program effectiveness reviews, “mock” Centers for Medicare and Medicaid Services (“CMS”) audits, CMS independent Validations Audits (CMS IAV’s) SNP MOC and Part C ODAG), Compliance Benchmarks, investigations, and consulting for large payers, providers, and PBMs.