Navitus Health Solutions

Analyst

• Maintain and administer Medicaid fee for service drug pricing methodologies in accordance with federal and state Medicaid requirements.
• Monitor and incorporate National Average Drug Acquisition Cost (NADAC) updates and related CMS guidance into pricing models and operational systems.
• Evaluate and apply HRSA 340B ceiling price considerations and exclusions as applicable to Medicaid reimbursement models.
• Ensure pricing methodologies align with state specific Medicaid reimbursement rules and contractual requirements.
• Accountable to cross-walk FDB to Medispan or visa versa to ensure compliance with State Medicaid Prescription Drug List and ensure ongoing reconciliation and updates.
• Support compliance with federal and state audit, reporting, and transparency expectations related to Medicaid drug pricing.
• Maintain and manage industry pricing and reference sources, including but not limited to Medi Span multisource and product codes (e.g., MONY indicators), NADAC pricing files, and HRSA 340B ceiling price date.
• Validate integrity, completeness, and timeliness of reference data used in pricing and modeling and resolve or escalate discrepancies.
• Assess industry changes that may impact Medicaid pricing assumptions or reimbursement outcomes.
• Maintain, and update financial models supporting Statements of Work (SOWs) for Medicaid fee for service pricing arrangements.
• Perform detailed pricing impact analyses to support SOW development, amendments, and renewals.
• Manipulate and analyze large data sets specific to SOW requirements, pricing guarantees, and reimbursement terms.
• Partner with internal stakeholders to ensure SOW pricing assumptions are accurate, documented, and supportable.
• Other duties as assigned.

Analyst, Government Pricing

Product Manager

• 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
• Other duties as assigned

Product Manager, Medicare Clinical Services

• Responsible for the oversight of Navitus’ contractual pharmacy network reimbursement accuracy
• Make independent assessments to confirm Navitus is conforming to contractual reimbursement obligations
• Review and monitor claims data, create, and update procedures
• Audit networks for price change accuracy, monitor compliance with Navitus pharmacy provider contracts
• Communicate findings, and work with applicable teams to remediate errors
• Analyze provider, client, and network performance for quality control and compliance
• Create reports to validate systems accuracy to Retail, Specialty, and Mail Order contractual terms

Pharmacy Contract Audit Analyst

Manager

• Provide direct managerial oversight for pricing analysts supporting Medicaid fee‑for‑service programs, including performance management, coaching, and professional development.
• Establish workload prioritization, quality standards, and delivery timelines aligned with State requirements and contractual obligations.
• Serve as escalation point for complex pricing, classification, and regulatory interpretation issues.
• Lead development and maintenance of Medicaid FFS pricing models, reimbursement methodologies, and financial risk assessments tailored to State‑specific program designs.
• Collaborate with other leaders to interpret Medicaid statutes, CMS guidance, State Plan Amendments (SPAs), and program‑specific initiatives to ensure compliant pricing strategies and deliverables.
• Support State budgetary planning through predictive trend analysis, including utilization shifts, generic penetration, biosimilar adoption, and market disruptions.
• Provide pricing and underwriting expertise in support of State negotiations, program amendments, audits, and inquiries.
• Accountable for administration and facilitation of quarterly State MAC performance reviews.
• Ensure all State reporting is delivered within the format and schedule as directed by the State contract.
• Act as subject matter expert for drug identification and classification, utilizing industry recognized sources, including Medi Span multisource codes, NADAC pricing benchmarks, and HRSA guidance and 340B ceiling price constructs.
• Lead analysis of generic and biosimilar drug market trends, including new to market generics, supply shortages across retail and specialty channels, and the impact on market volatility on Medicaid reimbursements and access.
• Oversee the end‑to‑end production, delivery, validation, and integrity of MAC, SMAC and 340B pricing files supporting Medicaid programs.
• Ensure ongoing reconciliation and validation.
• Establish controls and review protocols to ensure pricing accuracy, audit defensibility, and alignment with regulatory and contractual requirements.
• Partner with IT and Analytics to ensure data pipelines, pricing logic, and system outputs are accurate, reproducible, and documented.
• Respond to State, regulatory, and audit inquiries related to MAC methodologies, 340B pricing, and drug cost transparency.
• Collaborate cross‑functionally with IT, Regulatory, Legal, Analytics, Operations, and Finance to ensure aligned execution of Medicaid pricing strategies.
• Serve as the primary pricing liaison with external stakeholders, including State Medicaid agencies, data vendors (e.g., pricing compendia providers), and pharmacy and program partners.
• Other duties as assigned.

Senior Manager, Government Pricing

• Supports the development and maintenance of Medicaid Fee-for-Service pharmacy pricing and modeling aligned with the company’s mission, strategies, products, and services.
• Oversee core analytical work related to SOW requirements, including, Medicaid MAC pricing analysis, and 340B program impacts and compliance considerations.
• Develop, maintain, and enhance cost analysis and predictive trending models to support Medicaid FFS programs, segmented by SOW, pricing methodology, or program initiative.
• Lead and manage the capture, ingestion, and maintenance of external pricing files (e.g., NADAC, state MAC files, other benchmarks), including, performing data quality checks and validation, identifying and correcting anomalies or errors, conducting timely market research to support pricing accuracy and responsiveness, and resolve or escalate discrepancies, variance, or other anomalies.
• Create and maintain a formal Tier 2 inquiry process for MAC-related issues, including tracking inquiry volume, documenting resolution and outcomes, assessing financial and operational impact, and supporting trend analysis and escalation.
• Collaborate with other leaders to interpret and apply Medicaid regulations, state-specific requirements, and program initiatives to analytical models, pricing strategies, and reporting outputs.
• Collaborate with internal stakeholders (e.g., Client Services, Contracting, Operations, Compliance) to evaluate the financial and contractual impact of Medicaid pricing and program decisions.
• Interact with external stakeholders and vendors, building collaborative relationships to support pricing accuracy, data transparency, and program execution.
• Support leadership with ad hoc analysis, forecasting, and scenario modeling related to Medicaid FFS pricing, program changes, and regulatory developments.
• Assist leadership in supporting new Medicaid program initiatives, enhancements to pricing methodologies, and expansion of analytical capabilities.
• Contribute to the development of client- or state-facing materials and presentations, as needed, to explain pricing methodology, cost drivers, and program impacts.
• Periodic and detailed reporting of activities and opportunities to leadership.
• Other duties as assigned.

Senior Analyst, Government Pricing

• Operation and timely administration of the Navitus generic pricing programs including MAC, NADAC, or other pricing structures
• Responsible for fielding, analyzing, and resolving inquiries from pharmacy providers, clients, and internal teams
• May evaluate state MAC requirements to ensure Navitus MAC management remains compliant
• May manage quarterly and yearly pharmacy performance and/or reconciliations
• Monitor industry events to determine availability of generic introduction to the marketplace and manage exclusivity timeline for newly introduced generics
• Manage consolidation of generic manufacturers in the market that will affect MAC pricing
• Continuously review and proactively identify areas of opportunities for pricing and discount performance improvement
• Research customer and contract issues that may affect account planning, strategies, and proposals
• Assists with RFP responses as necessary
• Periodic and detailed reporting of activities and opportunities to Provider Services team and cross-functional leadership
• Research external and internal pricing trends and opportunities to contribute to overall pricing strategy
• Perform analyses as requested by internal and external business owners, or in support of identified business objectives, with special focus on pharmacy network profitability and/or client discounts
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives
• Other duties as assigned.

Reimbursement Analyst, Pharmacy Network

Bilingual

• Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS)
• Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services
• Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines
• Develop documentation standards for all clinical outreach
• Collaborate with other CEC staff to develop and maintain a high quality and consistent MTM product
• Assist CEC leadership to develop programs to support STAR ratings outreach
• Facilitate communication and education to clients, providers, and internal staff regarding MTM programs and program outcomes
• Provide clinical outreach to members, prescribers, and pharmacy providers in order to enhance care coordination
• Provide Medicare Part D clinical, operational and educational support by maintaining knowledge of all existing updates and regulations regarding the MTM program and Medicare Part C and D performance measures (STAR ratings)
• Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into the MTM and STARs programs, such that our clinical outreaches remain up to date
• Serve as a preceptor for APPE students within the CEC department
• Maintain open lines of communication with other functional areas/departments
• Develop a full understanding of Navitus Clients’ member experience and how the engagement center contributes to improved health and wellness
• Adhere to compliance and HIPAA regulations
• Other duties as assigned

Bilingual Pharmacist, Telehealth

Underwriter

• Develop and train analysts
• Interpret data models to establish pricing and forecast solutions to secure and retain business
• Maintain and further develop mechanisms to provide pricing and financial modeling for prospective and current clients
• Develop winning strategies and suggest opportunities to meet client objectives in collaboration with analysts, leadership, Customer Success, and Sales
• Deliver on-time pricing and ad hoc analyses as required
• Provide qualitative responses pertaining to pricing offers and associated strategies
• Determine reimbursement-pricing structures to align with organizational goals
• Identify and utilize internal and external tools for tracking, measuring, and forecasting of pricing, claims, and financial data
• Understand applicable data models and ensuring integrity of use of internal databases, such as CRM, PC2, Qlikview/QlikSense extracts, Medi-Span and other applicable databases
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives
• Other duties as assigned

Supervisor, Pricing and Underwriting

• Responsible for the operational oversight and management of products within the CEC and in collaboration with SMEs from other departments and division
• In collaboration with CEC leadership, define the product strategy and assure roadmap execution
• Assesses market competition by comparing the company’s product to competitor’s products
• Develop and continually improve strategies, objectives and policies for the assigned products/programs, and establish and monitor high performance standards and productivity measures/targets
• Recommend the nature and scope of present and future product lines by reviewing product specifications and requirements and appraising new product ideas
• Introduce and market new products by developing time-integrated plans with sales and marketing
• Provide product support for client implementations.
• Provide expert subject matter support to Navitus Client and Clinical Services Executives representing the client
• Supports the development and maintenance of product documentation including training materials, call scripts, client reports, etc
• Continually evaluate and monitor program metrics including turn-around times, CMR completion, patient satisfactions and accuracy in collaboration with CEC staff
• Other duties as assigned

Product Manager – Clinical Engagement Center

Product Manager, Medicare Part D Star Program

Artificial Intelligence

• Define and maintain the enterprise AI architecture strategy, including standards and reference architectures that support scalable adoption of AI, generative AI, and agentic AI capabilities across the organization.
• Establish and maintain enterprise AI architecture patterns, including design standards for generative AI, agentic workflows, retrieval-augmented generation (RAG), model orchestration, and enterprise AI service integration.
• Develop and implement AI governance frameworks and architectural guardrails to ensure responsible, secure, and compliant use of AI technologies across the enterprise.
• Define AI platform strategy by evaluating and recommending AI platforms, large language model providers, orchestration frameworks, and supporting tooling aligned with enterprise architecture standards.
• Establish AI integration patterns that enable AI capabilities to integrate with enterprise platforms, APIs, data platforms, and cloud services while maintaining scalability and reliability.
• Define and promote Agentic AI architectural patterns, including standards for workflow orchestration, tool integration, memory/context management, and human-in-the-loop capabilities.
• Ensure adherence to Responsible AI and regulatory compliance requirements, including standards for data privacy, auditability, model transparency, and ethical AI practices.
• Define architectural standards for AI operations (LLMOps/MLOps) including model lifecycle management, monitoring, observability, deployment pipelines, and operational controls.
• Establish AI security and cost management practices, including secure model access, data protection standards, usage controls, and architectural patterns that optimize AI infrastructure and consumption costs.
• Other duties as assigned.

Enterprise AI Architect

Risk

• Collaborate with subject matter experts, functional owners, data owners, and analysts to define and implement data governance policies, controls, and programs that ensure enterprise data is accurate, complete, secure, and reliable.
• Coordinate Data Management (MDM) processes and own the execution of enterprise data governance initiatives.
• Implement governance processes to ensure data integrity, quality, standards, and change management across business functions and systems.
• Coordinate master data activities with other organizational governance teams while adhering to established protocols and standards.
• Develop and maintain enterprise data standards aligned with organizational priorities and requirements.
• Maintain data governance documentation including master data definitions, data quality reporting inventories, enterprise data definitions, and governance policies and procedures.
• Continuously review and validate master data for quality, completeness, and consistency.
• Perform root cause analysis of master data issues and recommend and implement corrective actions.
• Develop and support communication and training materials related to data governance policies and processes.
• Other duties as assigned.

Director, Data Governance

Solutions Engineer

• Research utilization and capacity planning of existing technologies to plan for future growth
• Collaborate with other IT teams to perform a Proof of Concept for solutions that show promise
• Analyze and design effective and clear technical solutions for infrastructure and enterprise application related projects
• Act as subject matter expert on infrastructure and architecture items
• 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, provide guidance and diagnose issues that may be caused by server-side applications, server operating system issues and networking problems
• Recognized as a system expert in multiple core enterprise systems and be able to effectively provide knowledge training to peers
• Provide after-hours support
• Other duties as assigned

Enterprise Solutions Architect

Operations

• Lead and mentor practice managers to promote teamwork and high-quality end to end operation service.
• Cultivate a patient-centric environment, focusing on smooth operations and efficient patient flow.
• Responsible for the department’s budget.
• Ensure benefit compliance with federal and state laws.
• Conduct routine reviews and audits of team members.
• Lead meetings to drive operational efficiencies for new or existing processes.
• Manage capacity and pipeline planning for team.
• End to End Understanding of all Operational facets of the organization
• Lead multiple Operational teams both indirect and direct
• Provide training and mentorship to direct and indirect reports
• Meets performance targets for speed, efficiency, and quality.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.

Senior Director, Operations

• Design, build, and maintain enterprise AI solutions and services that enable the scalable adoption of generative AI, machine learning, and agentic AI capabilities across the organization.
• Implement enterprise AI architecture patterns and technical standards defined by the Enterprise AI Architect, translating reference architectures and design patterns into production-ready solutions.
• Develop and support AI integration patterns that connect AI capabilities with enterprise applications, APIs, data platforms, and cloud services.
• Build and maintain AI-enabled services and components, including model interfaces, orchestration services, agent frameworks, and reusable AI tooling for enterprise teams.
• Support the implementation of Agentic AI workflows, including orchestration, tool integration, context management, and human-in-the-loop capabilities.
• Implement and maintain AI operational capabilities (MLOps/LLMOps) including model deployment pipelines, monitoring, observability, lifecycle management, and operational controls.
• Ensure AI solutions align with enterprise AI governance, responsible AI standards, and regulatory requirements, including data privacy, auditability, and model transparency.
• Support AI platform development and enablement, working with Platform Engineering and Data Engineering teams to deploy, scale, and maintain enterprise AI infrastructure and tooling.
• Other duties as assigned.