Navitus Health Solutions

Operations

• Operationalize formulary information from various sources including FAC, P&T, Medispan and CAEs to coordinate the process of getting the information into the Formulary and Benefit Management System (FBMS) and then communicated to Benefits Systems and Auditing
• Coordinate implementation schedule of new clients
• Work with implementation team to streamline process for new client implementations
• Coordinate creating and building of unique formulary designs for custom clients
• Make independent decisions on formulary setup and maintenance when creating and building new formulary designs for custom clients which directly affects the bottom line of our clients
• Coordinate formulary document creation and posting, including maintenance of web, e-prescribing, formularies, change notifications, and medication program lists
• Trouble-shoot various formulary/set-up questions
• Review weekly Medispan Reports for specific changes that would affect the formulary
• Approximate travel required (5-10%)
• Other duties as assigned

Specialist II, Formulary Operations

Account Executive

• Support/back up the CAE, and Clinical Coordinator responsibilities
• Assist with escalated member/Client issue requests
• Develop and implement a clinical plan that meets the goals and objectives of the client and is in alignment with corporate business strategy
• Analyze client’s financial and utilization data to identify opportunities for improving health care and/or controlling drug and overall health care costs
• Actively participate in developing the clinical strategy for client
• Consultant on Plan/Benefit design recommendations
• Participate in development and delivery of annual reviews to client
• Consultant for formulary management and administration
• Other duties as assigned

Senior Clinical Account Executive

Product Manager

• Measure key performance indicators (e.g., uptake, clinical outcomes, mailing costs, mail return rate, ROI, etc.) for assigned clinical products and communicate areas of improvement
• Assess product capacity for managing new clients
• Participate in clinical product development and execute the product roadmap within scope, time and budget
• Develop a keen understanding of clinical products in the PBM industry to work collaboratively to expand product offerings, refine current product positioning, and develop key messages for both existing and potential clients
• Assist in analyzing the products performance, position, and utility for our clients and their members
• Participate in the development of marketing materials related to population health
• Conduct opportunity analyses for prospective clients in consultation with the Clinical Account Executives
• Develop and continually improve strategies, objectives, and policies for the assigned products, programs, and establish and monitor high performance standards and productivity measures, targets
• Assure appropriate testing has been conducted by staff for any system/app enhancement or break-fix
• Other duties as assigned

Product Manager, Population Health

• Ensure the timely and flawless execution of Medicaid clinical program mailings, reporting and interventions.
• Measure key performance indicators (e.g. uptake, clinical outcomes, mailing costs, mail return rate, ROI, Star Ratings and trends, revenue, etc.) for assigned clinical products and communicate areas of improvement.
• Assess product capacity for managing new clients.
• Participate in Medicaid clinical product development and execute the product roadmap within scope, time and budget.
• Develop a keen understanding of Medicaid clinical products in the PBM industry in order to work collaboratively to expand product offerings, refine current product positioning and develop key messages for both existing and potential clients.
• Assist in analyzing the products performance, position, and utility for our clients and their members.
• Ensure assigned Medicaid clinical products meet all regulatory requirements.
• Communicate with key cross-functional areas (Clinical Engagement Center, IT, Population Health, Customer Care, Finance, Client Services, and Clinical Services) about product executions in a timely and effective manner.
• Participate in the development of marketing materials related to Medicaid clinical services.
• Conduct opportunity analyses for prospective and/or current clients in consultation with the Clinical Account Executives or GCS Leadership.
• Articulate the clinical and technical aspects of the program and its benefit to our clients and members.
• Develop and continually improve strategies, objectives and policies for the assigned products / programs, and establish and monitor high performance standards and productivity measures / targets.
• Assure appropriate testing has been conducted by staff for any system/app enhancement or break-fix.
• Other duties as assigned.

Clinical Product Manager – Medicaid

• Ensure the timely and flawless execution of Medicare clinical program mailings, reporting and interventions
• Measure key performance indicators (e.g. uptake, clinical outcomes, mailing costs, mail return rate, ROI, Star Ratings and trends, revenue, etc.) for assigned clinical products and communicate areas of improvement
• Assess product capacity for managing new clients
• Participate in Medicare clinical product development and execute the product roadmap within scope, time and budget
• Develop a keen understanding of Medicare clinical products in the PBM industry in order to work collaboratively to expand product offerings, refine current product positioning and develop key messages for both existing and potential clients
• Assist in analyzing the products performance, position, and utility for our clients and their members
• Participate in the development of marketing materials related to Medicare clinical services
• Conduct opportunity analyses for prospective clients in consultation with the Clinical Account Executives
• Develop and continually improve strategies, objectives and policies for the assigned products/programs, and establish and monitor high performance standards and productivity measures/targets

Clinical Product Manager, Medicare

Project Manager

• Create, manage and document comprehensive medical management projects/project plans.
• Design the project goals and success markers, determine how success will be measured and tracked.
• Ensure the project remains on time and on budget and help motivate team members to hit their goals.
• Prepare and present status reports and ensure the project is achieving goals.
• Demonstrate thought leadership and subject matter expertise in the area of Specialty drug management through day to day interactions and public-facing presentations.
• Meet with clients to clarify specific requirements of each project.
• Make adjustments to project constraints based on financial analysis.
• Supporting role for internal program development and management.
• Manage vendor relationships
• Support system enhancement needs (i.e. JIRA)
• Member and Provider Correspondence management
• Responsible for day to day file audits to ensure receipt, processing and output as expected
• Influence overall company strategy by representing the voice of the customer and market feedback.

Lead – Project Management

Analyst

• Collaborates with benefit configuration analysts and internal customers using sound business judgement and expertise to research and determine root causes for claim processing issues of low to moderate complexity.
• Works simultaneously on multiple claim processing issues using subject matter expertise to enhance and improve the accuracy of claim processing.
• Acquires and maintains an intermediate to advanced level of knowledge and interpretation of benefit designs and adjudication system screens and functions.
• Applies advanced reporting and data analysis techniques to identify error types, root causes and quantity of claims affected.
• Establishes and utilizes standard templates to document and share a comprehensive summary of findings including a systemic impact analysis with CAO leadership and all relevant functional areas.
• Recommends retraining, new training and/or corrective action plans based on findings and works closely with benefit configuration trainers and coaches to take appropriate action to mitigate future occurrences and financial risk to client and/or Navitus.
• Adapts to industry changes and evolving technology, maintaining an intermediate to advanced level of understanding of both legacy and emerging products and systems.
• Uses departmental workflow management, issue resolution and reporting tools for troubleshooting and responding to moderate to complex customer requests.
• Independently assesses business needs and participates in process improvement, cost reduction and automation efforts.

Claims Analyst

Executive Assistant

• Support the VP or SVP(s) with schedules, telephone, email, filing and document organization, meeting preparation and follow up
• Prepare presentations, presentation slides and documents, and presentation support materials
• Maintain positive communications and rapport throughout the organization
• Assist VP or SVP(s) in ensuring enterprise-wide adherence to policies, procedures, compliance regulations, and other processes
• Assist all management and employees as a resource in areas of responsibility
• Organize and maintain a central corporate repository of documents and files
• Deal with multiple tasks daily, including prioritization and successful execution/resolution
• Prepare agenda and compile minutes as required for leadership meetings
• Conduct projects and participate in team activities to identify problems and improve work processes and systems
• Other duties as assigned

Senior Executive Assistant

Financial Planning and Analysis

• Administer the process for tracking capitalization of spending in accordance with the enterprise capitalization policy as set by the Accounting Department.
• Provide input to monthly journal entries.
• Provide advice and consulting on capitalization decisions, working with the Accounting Department as needed.
• Working with EPMO and IT, provide input to the Accounting Department for invoice accruals.
• Develop and administer the process for identifying in-service dates for capitalized assets and provide input to the Accounting Department for fixed asset accounting.
• Coordinate the development of project budgets and forecasts.
• Provide guidance, support and oversight to project managers and consolidate budgets and forecasts for reporting.
• Provide guidance and financial support to project managers and business owners to assist with identification and quantification of project benefits and financial value metrics (ROI, NPV, etc.).
• Develop annual capital plan and forecasting, including incorporating operating expense component of capital projects into financial budget and financial forecasts.
• Manage the tracking of actual project spend and tracking of other capital spend.
• Develop/redesign project and capital plan financial reporting.
• Lead financial reporting to various stakeholders including Senior Leadership Team.
• Provide reporting and support to the Strategic Transformation Office as needed.
• Lead presentation of results and discussions at monthly Capital Finance Review.
• Drive identification, tracking, and reporting of actual financial benefits derived from project and capital investments.
• Other duties as assigned.

Lead, Finance Capital Planning

• Work with the Manager to execute goals and objectives for Prior Authorization Operations Medicare reporting needs
• Execute on reporting requests, audit deliverables, monthly/quarterly Medicare reports, Ad Hoc report requests from clients and/or other internal departments, and support Manager in testing new reporting enhancements
• Execute on project work associated with Navitus’ Prior Authorization Operations Medicare reporting from inception through completion
• Troubleshoot for reporting issues or questions
• Ensure controls are in place that adequately ensure quality in Prior Authorization Medicare report deliverables
• Work with end users to suggest enhancements to the system or workflow processes to meet the needs of the business.
• Identify enhancement requirements for new processes, services and changes to existing processes and services to achieve department business and strategic goals
• Other duties as assigned

Analyst, Medicare Audit – Reporting

Accounting Manager

• Prepare accurate and timely financial statements, reports, and analyses for internal and external stakeholders
• Assumes primary responsibility for general ledger accounting, ensuring appropriate internal controls are in place, and all transactions and journal entries are timely and accurate
• Provide leadership over the month-end and quarterly close process, ensuring timely and accurate reporting
• Participate in budgeting and forecasting activities, contributing to the company’s financial planning
• Oversees staff accountable for the fixed asset accounting records, including custodial information
• Participate in annual financial and retirement plan audits by coordinating requests, reviewing financial statement and preparing footnote disclosures
• Establish and maintain the organization's accounting principles, practices, procedures, policies and initiatives on new accounting guidelines for effective adoption
• Responsible for the overall direction, coordination, and evaluation of team including interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems
• Lead the team through improvement projects for key financial/ERP systems and other business processes
• Other duties as assigned

Senior Manager, Accounting

Architect

• Research into new technologies which may be applicable to the environment at Navitus
• Research into utilizing capabilities of existing technologies to a greater extent
• Collaborate with other IT teams to perform a Proof of Concept for solutions that show promise
• Work with business teams to understand current processes to identify areas which could see process improvement through technology solutions
• Analyze and design effective and clear technical solutions for infrastructure and enterprise application related projects
• Assist in the development and implementation of corporate information system policies and procedures
• Maintain knowledge in Infrastructure Operations, Data Center Operations, Virtualization (Server, Network, Storage, Desktop, and Application); attend conferences, meet with vendors, and keep current on technology trends
• Analyze and diagnose issues that may be caused by server-side applications, server operating system issues and networking problems
• Other duties as assigned

Enterprise Application System Architect

Software Engineer

• Define, develop, and document software business requirements, objectives, deliverables, and specifications on a project-by-project basis in collaboration with internal users and departments
• Design, develop, document, and implement new applications and application enhancements according to business and technical requirements
• Consistently write, translate, and code software programs and applications according to specifications
• Write new and modify existing programming scripts to enhance functionality and/or performance of company applications as necessary
• Design, run and monitor software performance tests on new and existing programs for the purposes of correcting errors, isolating areas for improvement, and general debugging
• Generate statistics and write reports for management and/or team members on the status of the programming process
• Train end users to operate new or modified programs
• Utilize Unix/Linux shell scripting, Informatica/Talend, C# and .NET(required), React (required), AWS Cloud Development, CDK, Oracle, Telerik, MS SQL, PostgreSQL or other noSQL database development experience, and Visual Studio/Team Foundation Studio
• On-call availability and some travel may be required
• Other duties as assigned

Developer II, Application Systems

Procurement

• Execute daily purchasing tasks including order placement, tracking and inventory management.
• Maintain and develop as needed, accurate and up-to-date records of all purchasing transactions (trackers / dashboards).
• Reconcile invoices against inventory receipt to identify and resolve shortages or overages within an order.
• Reconciliation of purchase orders entered into inventory management system against invoices to ensure accurate pricing is reflected.
• Monitor primary and secondary vendor agreements for compliance with generic compliance and minimum volume commitments.
• Ensure / communicate timely availability of inventory to meet operations team requirements.
• Develop and manage relationships with key suppliers.
• Utilize data analytics to identify opportunities for cost savings and process improvements.
• Continuously evaluate and refine procurement strategies to meet changing business needs and market conditions.
• Track pull through and ensure alignment between inventory levels and sales forecasts.
• Analyze market trends to inform purchasing decisions and anticipate potential supply chain disruptions.
• Monitor supplier performance and market conditions to identify risks and opportunities.
• Contribute to the department goal of improved efficiency and effectiveness, including the capture of strategic client opportunities using approved reference resources that support proposal and presentation development activities.
• Other duties as assigned.

Inventory and Procurement Specialist

Data Analyst

• Responsible for completing reports and projects, such as detailed geo access, member disruption, state PBM licensing applications, state audit/adequacy reports, and pharmacy listing.
• Work closely with the legal team to develop a significant understanding of state PBM and Pharmacy Access laws in order to build reports and capture applicable data to meet regulatory requirements.
• Point of contact for team members, providing both support and data knowledge.
• Provide support to key client needs in order to meet their specific business needs.
• Recommend enhancements to existing systems in accordance with business needs by creating ad hoc and standard reports as well as new information delivery technologies.
• Understand intermediate data relationship concepts and transform data into information that can be proactively used to improve business decisions.
• Lead evaluation of applicable pharmacy network adequacy as required by clients or regulation.
• Create pharmacy directories for our clients and their members that clearly identify the pharmacy services available to them and where they are located.