US Claro

Pharmacist

• Initiate prescription prior authorizations on behalf of prescriber’s offices
• Coordinate and confirm with patients’ prescription deliveries
• Initiate contact and create new potential clinic/prescriber relationships
• Communicate current and relevant prescription, insurance and financial needs as they relate to appropriate pharmacists, providers, clinical support staff and patients
• Interacts with clinic employees, including but not limited to pharmacists, clinical staff, fiscal personnel, department managers, access services staff, coding staff, and billing assistants
• External contacts include but are not limited to third party payers, manufacturers, prescription benefit management companies, external pharmacy personnel, and referring providers and their support staff
• Serves as the liaison between the medical staff, outpatient pharmacies, insurance providers and patients to improve communication and continuity of care
• Other duties as assigned

Referral Coordinator, Specialty Pharmacy

• Responsible for answering the inbound calls from patients, prescribers, and other healthcare professionals
• Responsible for contacting doctors to obtain necessary prescription information to properly fill a prescription
• Responsible for managing the queues and working oldest orders first
• Responsible for the correct shipment of the specialty pharmacy orders
• May be responsible for ensuring adequate inventory of pharmaceuticals in the pharmacy, including ordering, receipt, verification of orders, and stocking of pharmaceuticals and supplies
• The Employee will act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve

Pharmacy Technician I

• Perform packaging and shipping duties based upon established protocols that take medication storage requirements and final shipping destination into account.
• Assist in the receipt and stocking of pharmaceuticals and supplies within the pharmacy.
• Demonstrate flexibility in scheduling and the capacity to work overtime as required.
• Act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve.
• Other duties as assigned.

Fulfillment Specialist, Specialty Pharmacy

Business Intelligence Developer

• Use Qlikview, QlikSense, SQL Server Management Studio, Oracle SQL Developer, and other tools to create applications and data models for reporting needs.
• Develop reporting application scripts that import data from various sources.
• Identify inter-departmental dependencies and downstream impacts of changes within reporting applications.
• Recognize and suggest alternative data solutions when applicable.
• Communicate effectively and work closely with a variety of users to develop in BI applications, validate effectiveness, and conduct user testing.
• Adapt quickly to changing reporting requirements and new BI tools in a rapidly evolving, high-growth organization.
• Facilitate in ongoing data validation to ensure data integrity and reliability.
• Collaborate with other teammates to deliver effective solutions.
• Initiate collaborative relationships with business stakeholders and IT.
• Research, suggest, and contribute to brainstorming development opportunities.
• Identify and provide insights into streamlining analytics processes and research improvement opportunities.
• Other duties as assigned.

• Responsible for answering the inbound calls from patients and doctors’ offices
• Responsible for contacting doctors to obtain necessary prescription information to properly fill a prescription
• Responsible for the correct shipment of the specialty pharmacy orders
• Responsible for ensuring adequate inventory of pharmaceuticals in the pharmacy, including ordering, receipt, verification of orders, and stocking of pharmaceuticals and supplies
• Responsible for accurate and appropriate completion of clinical pathway information as instructed within questionnaires
• Responsible for managing failed claims in a timely fashion
• Responsible for a working knowledge or copay programs, HUB programs, and billing the programs
• May be responsible for inventory management and entering new inventory into the software
• Other duties as assigned

Pharmacy Technician II

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

Product Manager

• Work with Prior Authorization Leadership to execute goals and objectives for Navitus’ Prior Authorization System
• Ensure successful execution of testing of system enhancements, writing detailed test cases, managing bugs, and documenting results within required timeframes
• Maintain business process knowledge around the clinical and PA Specialist day-to-day processes
• Ensure that system enhancements, testing issues, and information about PA system releases are communicated timely to the Clinical and PA Operations team
• Execute on project work associated with Navitus’ Prior Authorization System from inception through completion. Ensure implantation is successful and seamless for end users
• Work with end users to suggest enhancements to the system or workflow processes to meet the needs of the business.
• Identify and document requirements for new processes, services, and changes to existing processes and services to achieve department business and strategic goals
• Perform setup and maintenance of system configuration
• Provide after-hours support as needed
• Other duties as assigned

Product Manager, UM Technology

Data Analyst

• Design, maintain, and optimize data pipelines (ETL/ELT) supporting analytics, reporting, and operational workflows.
• Collaborate with business stakeholders to define data requirements and translate them into practical solutions.
• Write efficient SQL queries and work with tools such as SSMS, PowerBI, and Excel.
• Analyze, model, and validate data to ensure accuracy, consistency, and usability.
• Promote data stewardship and governance best practices.
• Identify opportunities for automation, scalability, and continuous improvement.
• Navigate and improve organically grown legacy systems while contributing to modernization initiatives.
• Participate in, adhere to, and support compliance, people and culture, and learning programs.
• Perform other duties as assigned.

Senior Data Analyst

Manager

• Provide leadership, training, supervision, and strategic direction to department Pharmacists and Product Managers.
• Assist with the fiscal management of the department, including forecasting, budget development, staffing, and trending of programs in support of Navitus’ strategic and business initiatives.
• Proactively anticipate and solve population health related issues.
• Lead the development of new clinical programs and manage the maintenance and continuous improvement of existing programs, to keep innovation and evidence-based programs a differentiator for Navitus.
• Serve as a key stakeholder and decision-maker on implementation of new clinical requirements.
• Have strong knowledge of current standards, regulations, and guidance including CMS, PQA, and HEDIS measures and have the ability to concisely communicate that information to stakeholders and clients.
• Assist RPD with the accredited PGY1 Managed Care Residency Program.
• Support URAC and NCQA clinical initiatives and projects as needed.
• Other duties as assigned.

Senior Manager, Population Health

Content Marketing Manager

• Primary administration and integration within our SaaS Enterprise Content Management (Document/Workflow) Suite.
• Ensure all environments are managed and maintained to meet service level agreements.
• Implement Security measures and access controls.
• Support change control and testing processes for modifications to application systems.
• Analyze system for overall performance and give recommendations for improvements.
• Provide responsive technical assistance and document configuration to support processes.
• Develop strong working relationships with third party vendors.
• Research and recommend innovative, and where possible automated approaches for system administration tasks.
• Identify approaches that leverage our resources and provide economies of scale.
• Quick, efficient, and effective issue resolution with proactive communication to all stakeholders.
• Recommend, schedule, and perform improvements, patches, and reconfigurations.
• Develop, document, and maintain policies, procedures and associated training plans for system administration and appropriate use.
• Work with additional functional teams to ensure optimal operations and uptime of application environments.
• Proactive monitoring and maintenance of SaaS / Windows system environments.
• Provide backup administration support to other teammates.
• Provide after-hours support.

Administrator II, Enterprise Content Management

Call Center Representative

• Lead operational redesign and define business strategies that improve service performance, scalability, and operational efficiency across Customer Care.
• Establish and oversee integrated staffing models, cross-training strategies, and operational workflows across Customer Care, including PA Intake, specialized teams, and customer communications.
• Partner with IT leadership to ensure Customer Care systems and applications effectively support operations, analytics, and reporting, with ongoing evaluation to optimize performance and scalability.
• Serve as the accountable business owner for company customer and member experience initiatives, providing end-to-end leadership from strategy development and innovation through execution, adoption, and sustained results.
• Define performance standards, service metrics, and operating benchmarks to drive accountability and consistently exceed service-level expectations.
• Establish strong cross-functional working relationships between Customer Success, Clinical Services, Technical Operations, and Government Programs, Sales and Implementation departments to ensure seamless service delivery and client onboarding.
• Provide strategic oversight of Customer Care workforce planning, forecasting, and capacity modeling by analyzing demand trends, developing forecasts, researching business requirements, workflow design, and business growth requirements.
• Lead forward-looking strategy and the adoption of innovative methodologies to continuously enhance call center capabilities, operational performance, and technology advancement.
• Drive a culture of continuous operational improvements focused on enhancing customer experience, operational effectiveness, and quality outcomes.
• Set strategic direction for associate training, leadership development, and call center certification to ensure workforce readiness and performance excellence.
• Evaluate emerging technologies, systems, and sourcing strategies to strengthen Customer Care capabilities and improve serve delivery.
• Oversee the development, implementation, and governance of Customer care policies, procedures, and quality frameworks, including performance monitoring and corrective action.
• Ensure robust tracking, trending, and reporting of operational metrics, performance guarantees, and service outcomes.
• Provide oversight of accreditation, including application preparation, compliance maintenance of necessary documentation to demonstrate compliance with accreditation standards and coordination of on-site reviews.
• Other duties as assigned.

Senior Director, Healthcare Member Contact Center

Operations

• Conduct operational redesign and develop and execute business strategies that increase service levels, operational capabilities, and efficiencies
• Direct and oversee Patient Services and Specialty Programs staffing requirements by analyzing trends, developing forecasts, researching business requirements, and analyzing workflows
• Collaborate with IT leadership to ensure necessary systems and applications are in place to support fulfillment operations
• Develop and implement strategic plans for the operational infrastructure of systems, processes and personnel designed to accommodate the growth objectives and new service offerings
• Develop and implement continuous operational improvements focused on enhancing the level of patient care while optimizing the customer experience
• Collaborate with leaders from across the organization to optimize processes to improve efficiency, safety, and patient experience
• Ongoing monitoring, evaluation, and reporting of pharmacy service KPIs to other Pharmacy Managers and Executive Leaders
• Assist in the creation and reporting of ongoing Quality Improvement Projects
• Investigate, present, and create business cases around new technology solutions and/or processes to aid in either more efficient pharmacy fulfillment operations or enhanced patient experience
• Develop and oversee an efficient, cost effective, safe, and patient-centric fulfillment strategy across all fulfillment locations

Director, Specialty Pharmacy Fulfillment Operations

• Make decisions regarding the resolution of pharmacy issues
• Establish and maintain contracts with pharmacy providers
• Facilitate submittal, receipt, tracking, and process flow of contracts between Navitus and providers
• Accurately enter information and maintain contract database
• Generate reports on network performance to monitor the claims accuracy throughout the terms of the contract
• Responsible for creating networks based on the contract terms within the claims processing system and ensure accuracy with performing quality reviews
• Assist in resolving intricate pharmacy provider issues and complaints
• Coordinate pharmacy network communication efforts including collection of content, disseminating information to provider partners through appropriate channels, and tracking response metrics
• Other duties as assigned

Pharmacy Relations Specialist

• Perform telephonic consultations with patients regarding the use of their specialty medication and management of their disease state.
• Perform medication reconciliation, screen for potential drug interactions, and provide side effect management recommendations.
• Interpret physicians' prescriptions and contact prescribers for prescription clarification.
• Expedite the processing of orders and verify prescription information.
• Provide patient education through telephonic consultations in accordance with Lumicera’s Patient Management Program.
• Adapt to new workflows and processes, solve unique pharmaceutical problems, and stay current with advancements in specialty pharmacy therapies.
• Back up other pharmacists as needed and document medication errors per company policies and procedures.

Pharmacist, Clinical Consultation

QA Engineer

• Test assigned stories for acceptance criteria and regression testing while utilizing a continuous “test to break it” approach
• Participate in Sprint ceremonies based upon assigned initiatives
• Participate in QA Community of Practice
• Consider automation and work with sister teams to help implement, test and communicate updated scripts
• Perform overall risk analysis for assigned testing stories
• Escalate barriers to completion to Manager
• Creation of dashboard and documentation necessary as required by the testing scope of requested initiatives
• Manage internal and external customer expectations and other Navitus stakeholder expectations
• Assume accountability for providing & improving quality testing metrics associated with projects, portfolios and IT departments
• Other duties as assigned