Navitus Health Solutions

Clinical Operations

• Verify prescriptions for pharmaceutical preparations and devices for patients at company facilities; maintain accurate and detailed records of all prescription transactions, and submit appropriate claims for third-party reimbursement;
• Consult with physicians and nurses regarding pharmaceutical questions; advise physicians on formulary medications and cost-effective and innovative therapies; answer pharmaceutical questions from patients and staff;
• Monitor storage, distribution, and use of pharmaceuticals; provide clear, detailed clinical documentation of patient consultations and interventions in pharmacy software in compliance with internal policies and procedures and external regulatory bodies (such as URAC) and/or EMR systems efficiently;
• Provide oversight and quality assurance to pharmacy technicians;
• Interpret and clinically evaluate prescriptions for specialty medications based on available information and resources;
• Contact providers and/or patients to verify information related to prescriptions such as drug strength, intended directions, and diagnosis to expedite processing of orders;
• Verify and confirm validity of controlled substances;
• Contact providers for new prescriptions, consult with prescribers and nurses regarding clinical questions, and contact pharmacies for prescription transfers;
• Work with providers to convert prescriptions to generic, biosimilar, or preferred drugs whenever possible;
• Verify prescription information entered in the system by data entry or order entry;
• Answer clinical questions from the pharmacy team;
• Adapt to new workflows and processes;
• Solve unique pharmaceutical problems;
• Stay current with advancements in specialty pharmacy therapies, including new drug approvals and specialty disease state treatment guidelines;
• Provide patient education through telephonic consultations for patients of the specialty pharmacy in accordance with Lumicera’s Patient Management Program.

Pharmacist, Clinical Operations

Operations

• Understand plan formulary design and rebate potentials for client specific set ups.
• Analyze claims data to ensure the accuracy of group purchasing organization (GPO) rebate processing, direct contracts with pharmaceutical manufacturers, and establish recommendations to clients for rebate optimization.
• Provide sales and request for proposal (RFP) support for prospective clients, client renewals, and market checks.
• Work closely with the Navitus Finance and Underwriting teams to assist with evaluating rebates and manage risk in pricing.
• Support contract review, data entry, evaluation, and reconciliation of Navitus client rebate financial guarantees.
• Understand the department and customer business needs and facilitate successful delivery of information for decision-making.
• Serve as direct contact for Navitus Client Services attending client calls as needed regarding client specific rebate reporting, rebate guarantee questions, and data analysis.
• Coordinate with Analytics on the maintenance of the Navitus 3D Rebate reporting environments.
• Assist in managing new rebate program initiatives and the expansion of rebate forecasting.
• Serve as the Navitus representative and subject matter expert for Navitus audits, to include internal, external, manufacturer, client, and regulatory program audits.
• Lead and coordinate Government-related or regulated reporting for internal use and client requirements.
• Maintain a basic understanding of pharmaceutical manufacturer rebate contracts, submissions and all deliverables to trade or third-party entities.
• Review GPO strategy and pharmaceutical manufacturer contracts to accurately set up and maintain parameters in the rebate processing system, and correctly allocate rebate payments.
• Other duties as assigned

Analyst, Rebate Operations

Security Engineer

• Act as subject matter expert on infrastructure, security and network architecture.
• Serve as a security team advisor on corporate projects, providing technical security consultations on highly complex business projects.
• Research utilization and capacity planning of existing technologies to plan for future growth.
• Analyze and design effective and clear technical solutions for infrastructure and enterprise security related projects.
• Collaborate with other IT teams to perform a Proof of Concept for solutions that show promise.
• Assist in the development and implementation of corporate information security policies and procedures, strategies, including deployment, administration, configuration and support of security related systems.
• 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, provide guidance and diagnose security incidents and may cause a threat to Navitus’s security and safety.
• Recognized as a system expert in multiple core enterprise systems and be able to effectively provide knowledge training to peers.
• On-call availability. Some travel may be required. Provide after-hours support. Other duties as assigned.

Enterprise Security Architect

Manager

• Develop and maintain subject matter expertise in operational tools and software applications including, but not limited to, RxVector/Agile Care, NCRX, Lighthouse, CoverMyMeds, Lumicera Digital Engagement Programs for Patients and Providers, Manufacturer Patient Assistance Programs, Manufacturer Enhanced Services Programs, Phone System(s), CRM, Alvaria, Jira, and Electronic Medical Record navigation, communication, and documentation.
• Partner with Health System pharmacy, finance, and revenue cycle leaders to ensure aligned charging, billing, and reimbursement workflows.
• Provide financial impact analysis for new specialty therapies, biosimilars, site-of-care shifts, and program expansions.
• Proactively communicate opportunities and risks for 340B program qualifications to Lumicera and Navitus partner organization leadership based on current and future changes to the 340B Program landscape.
• Develop reporting and presentation on the current performance and additional opportunity analysis for Lumicera and Navitus partner organizations participating in the 340B program.
• Support appeals strategies and remediation plans for recurring pharmacy reimbursement issues.
• Effectively utilize analytics to track and trend successes and opportunities both internally at Lumicera, as well as externally with partners.
• Developing and maintaining subject matter expertise is expected in software applications including, but not limited to, electronic health records, 340B third-party administrator platforms, Qlik-Sense, Navigate 3D, Microsoft Excel, Microsoft PowerPoint, SharePoint, Cisco, Genesys, and Alvaria.
• Develop and maintain policies and procedures in scope of 340B compliance and optimization for Lumicera pharmacy operations in relation to partnerships with Covered Entities.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• May provide functional supervision to professional, paraprofessional, and support staff in their respective pharmacy, including training, assigning duties, and providing input for performance evaluations.
• Identify and present opportunities for workflow and process improvement to direct manager and/or Lumicera Leadership.
• Develop and update training resources that effectively facilitate education on the unique aspects of 340B specific to the IDN Specialty Pharmacy workflows, programs, and individual locations.
• Represent Lumicera and affiliated IDN organizations with a high degree of professionalism in all interactions within scope both inside and outside of the workplace.

Manager, Health System Pharmacy Revenue Integrity

Account Manager

• Manages assigned vendors within established governance, policies, and escalation frameworks.
• Coordinate forecasts/resource projections between vendor and internal Lumicera department as needed.
• Ensure vendor access to systems proprietary information, and/or protected health information is appropriate and compliant based on delegated services.
• Support contract management activities in coordination with Procurement, Vendor Risk Management, Legal, and Finance as well as other departments (e.g., Ops, IT) including but not limited to scope changes, renewal impacts and termination notifications.
• Evaluate performance and proactively provide feedback to vendor(s) to increase customer satisfaction, efficiency, and effectiveness.
• No less than quarterly, establish review forums with vendors to analyze, discuss, and provide feedback on performance as well as facilitate mutual input, with an improvement mindset – such as corrective action plans.
• Provide recommendations to vendor(s) and leadership on vendor performance, risk mitigation, and improvement opportunities.
• Lead regular calls with appropriate internal and external parties aimed at identifying and solving top issues affecting the customer(s) (internal and external).
• Collaborate with vendors and Lumicera affiliates to ensure mutual understanding of goals and roles and responsibilities of each in achieving those goals across entities.
• Oversee invoices to ensure billing is appropriate based on scope or Statement of Work (SOW) and that payment is managed timely.
• Keep Lumicera (or internal client department) and vendor informed of all upcoming customer-facing testing and updates to products or services that could generate customer inquiries and/or result in process changes or potential/expected outages.
• Institute best practices by conducting process reviews and memorializing process improvements via documentation.
• Lead monthly and/or quarterly KPI and performance evaluations with vendor teams, ensuring that goals are clear and optimal performance levels are reached.
• Other duties as assigned.

Vendor Relationship Manager

• Coordinate the development, delivery, marketing, and service of specialty products across benefits with enterprise partners
• Develop and deliver a medical data center of excellence to support organization initiatives
• Create department-level objectives and strategies in support of corporate mission, vision, and objectives
• Manage products and services related to high-cost medications across benefit coverage to meet business objectives
• Deliver accurate budget projections for revenues and expenses of products and services under management
• Lead strategic planning with Customer Success on industry, market, and client-specific offerings
• Survey competitive landscape to provide business intelligence inputs on related programs and services
• Manage partnerships within enterprise and external vendors
• Establish and monitor performance standards and productivity targets and guide continuous process improvement initiatives accordingly
• Create a supportive environment of learning and development for associates to support engagement and business objectives
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned

Senior Manager, Medical & Specialty Products

Compliance

• Drive cross‑functional operational requirements and implementation (scope, milestones, owners, dependencies, and success criteria) spanning Product, Operations, Technology, and Customer Success.
• Coordinating complex pharmacy benefits relationships through operational and contract understanding, inter-entity dynamics, and reimbursement structures and strategies.
• Facilitate solution design to reflect regulatory intent and operational practicality.
• Manage traceability from requirement to control to process/tech change to evidence.
• Define/validate preventive & detective controls; align with policies, standards, and procedures.
• Establish accompanying fit‑for‑purpose evidence models (reports, dashboards, logs, audit trails) and/or testing protocols to demonstrate ongoing adherence to regulatory requirements.
• Ensure policies, procedures, desk‑level work instructions, and training are updated prior to effective dates.
• Coordinate change readiness and adoption with affected teams including recommending content relevant to client impact and experience.
• Exercise authority to gate/hold releases when regulatory or control gaps create material risk, escalating through leadership as needed.
• Sign‑off authority on control adequacy and evidence sufficiency for go‑live operational readiness.
• Monitor reduction in post‑go‑live defects and implement root cause analysis or defect remediation plans supportive of the regulatory environment.
• Other duties as assigned.

Principal, PBM Business and Regulatory Strategy

• Serves as the support Navitus contact for the pharmaceutical manufacturers principally responsible for annual Med D renewal process and reporting
• Primary point of contact for the Rebate Account Specialists when addressing issues related to rebate contract submission, reconciliation, and allocation
• Reviews pharmaceutical manufacturer contracts and makes independent decisions on the set-ups of the contract parameters
• Manages operational relationship with Pharmaceutical Manufacturers with the Rebate Operations Team plus provides management and finance with the Rebate reconciliation reports quarterly and on an annual basis
• Manages operational relationship with rebate GPO partner and monitors performance guarantees
• Responsible for IRC related audits, reporting, and client questions
• Manage specialty rebate programs including VIO, VBC, Medical, and Point of Sale
• Leader of the prospective rebate tracker and contract administration management for all of IRC
• Assist the Associate Directors in annual performance reviews and goal setting for the Rebate Account Analysts and handles the performance management responsibilities for assigned Analyst/Specialists
• Other duties as assigned

Manager, Rebate Operations

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
• Maintain positive communications and rapport with Navitus clients
• 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
• Other duties as assigned

Senior Executive Assistant

• Lead and support a team of software developers, ensuring alignment with business goals and technical standards by ensuring alignment with business goals and technical standards.
• Mentor team members through regular coaching, training opportunities, and performance evaluations.
• Monitor team productivity and quality; provide performance insights and feedback reports to senior leadership.
• Collaborate with stakeholders to understand requirements and ensure timely delivery of development solutions.
• Oversee production support and manage incident resolution in accordance with established SLAs.
• Lead the team in maintaining detailed and up-to-date documentation of issues, resolutions of the solution procedure.
• Lead the team in maintaining and updating application configurations, including user security, to meet business requirements.
• Guide the team in maintaining comprehensive documentation for codebases, issue resolution, and development procedures.
• Manage and prioritize service requests, enhancements, and bug fixes to support product stability and growth.
• Communicate planned and unplanned outages in a timely manner.
• Plan and execute regular codebase maintenance and refactoring to ensure system health.
• Prepare and present operational dashboards and KPIs to track team performance and delivery metrics.
• Coordinate cross-functional projects and ensure smooth collaboration between development and support teams.
• Contribute to annual budgeting and resource planning for development initiatives.
• Conduct annual BCDR exercises to ensure system support documentation is current and recovery processes are optimized.
• Provide after-hours and on-call support as needed for critical deployments and incidents.
• Other duties as assigned

Manager, Application Systems Development

Call Center Representative

• Manage contact center operations to ensure consistent delivery of high-quality service to members, pharmacies, and doctor’s offices via phone and email.
• Oversee scheduling to meet service level agreements and business goals.
• Oversee and improve support process and procedures, ensuring timely and accurate responses to member, pharmacy, and doctor’s office inquiries.
• Coach, mentor, and develop team leads and frontline representatives to foster engagement, growth, and performance improvement.
• Oversee performance management including call center metrics, call quality, customer satisfaction.
• Create action plans when performance goals are not met.
• Handle complex or escalated customer issues when necessary, ensuring timely resolution.
• Participate in, adhere to, and support compliance, people and culture, and learning programs.
• Perform other duties as assigned.

Manager, Contact Center

• Lead and support team by ensuring alignment with business goals and technical standards.
• Mentor team members through regular coaching, training opportunities, and performance evaluations.
• Monitor team productivity and quality; provide performance insights and feedback reports to senior leadership.
• Collaborate with stakeholders to understand requirements and ensure timely delivery of development solutions.
• Oversee production support and manage incident resolution in accordance with established SLAs.
• Lead the team in maintaining detailed and up-to-date documentation of issues, resolutions of the solution procedure.
• Lead the team in maintaining and updating application configurations, including user security, to meet business requirements.
• Guide the team in maintaining comprehensive documentation for codebases, issue resolution, and development procedures.
• Manage and prioritize service requests, enhancements, and bug fixes to support product stability and growth.
• Communicate planned and unplanned outages in a timely manner.
• Plan and execute regular codebase maintenance and refactoring to ensure system health.
• Prepare and present operational dashboards and KPIs to track team performance and delivery metrics.
• Coordinate cross-functional projects and ensure smooth collaboration between development and support teams.
• Contribute to annual budgeting and resource planning for development initiatives.
• Conduct annual BCDR exercises to ensure system support documentation is current and recovery processes are optimized.
• Provide after-hours and on-call support as needed for critical deployments and incidents.
• Other duties as assigned

Manager, Application Services

Paralegal

• Manage licensing processes for Navitus and its subsidiaries
• Draft legal documents and templates, managing document templates and corporate legal records
• Perform records and legal research and prepare correspondence under general supervision
• Identify, review, and interpret legislation and regulatory environment changes impacting Navitus
• Provide support and analysis related to the interpretation and adoption of policies, processes, and procedures related to applicable regulations

Attorney

• Imparts the philosophy, values, mission and vision of Navitus and SSM Health and facilitates the integration of values in Continuous Quality Improvement (“CQI”) activities.
• Draft, review, and negotiate contracts on behalf of the organization.
• Oversee the complete life cycle of Navitus’ contracts from initial request to final signature.
• Field internal and external requests on the status of contracts, and manage follow up with staff as needed.
• Prepares additional legal documents, such as memorandums and correspondence.
• Inform the development of new Navitus initiatives from a legal perspective and provide guidance on legal issues that help shape the organization’s direction and impact as a whole.
• Provides legal counsel to Navitus’ staff members on the implications of their business objectives and ensure that all of Navitus’ staff are informed of applicable policies and practices.
• Researches and analyzes statutes, judicial decisions, legal articles, contracts, and legal codes.
• Files legal documents and correspondence in digital and physical filing systems.
• Develops processes for the effective indexing and filing of legal documents and managing contracts.
• Other duties as assigned

Senior Staff Attorney

Project Manager

• Lead and coordinate regulatory projects from initiation through completion, operationalizing requirements to meet state or federal standards and ensuring alignment with organizational goals.
• Schedule and facilitate project meetings to ensure progress and alignment with all stakeholders and taskforce while building strong relationships through proactive communication.
• Document key details, including meeting transcripts, action items, and assignments; share documentation with participants and ensure timely completion of action items.
• Maintain and update internal processes, leveraging tracking systems to monitor progress.
• Oversee cross-functional implementation of regulatory initiatives across multiple departments, managing timelines, resources, and deliverables.
• Lead issue management by reporting issues and proposed solutions to impacted parties and driving them through to resolution.
• Partner with Regulatory Auditor to develop processes for conducting compliance reviews and spot audits to monitor adherence to regulatory standards and identify areas for improvement.
• Develop and manage project plans using project management tools, driving process redesign or improvements, and automation initiatives, may include assisting departments with creation of work instructions and forms.
• Prepare and present detailed analyses and reports, synthesizing findings and recommending corrective actions and process enhancements.
• Travel as required (less than 25%).
• Other duties as assigned.