Navitus Health Solutions

Reimbursement Specialist

• Follow standard operating procedures to obtain and process manufacturer copay assistance program reimbursement
• Monitor claims activity for accuracy and successful submission
• Ensure patient billing information is set up appropriately in pharmacy software
• Participate in conferences and meetings related to reimbursement/billing
• Respond to employee, patient, and client questions or complaints regarding reimbursement and/or billing
• Work with internal teams to review and resolve claim issues
• Maintain accurate reference information relating to reimbursement and copay assistance
• Document information, insurance, and prescriptions/orders accurately and thoroughly within patient profiles
• Comply with applicable federal and state laws and ethical standards
• Perform other duties as assigned

Reimbursement Specialist I

Pharmacist

• Share pharmacy experience and career interests with Navitus Talent Acquisition
• Be considered for future Clinical Prior Authorization Pharmacist opportunities
• Stay connected with Navitus as future opportunities become available
• Submit a resume to join the Clinical Prior Authorization Pharmacist Talent Community

Clinical Prior Authorization Pharmacist

Accountant

• Prepare, review, and post journal entries
• Maintain and monitor general ledger account reconciliations; investigate and resolve reconciling differences
• Reconcile intercompany account balances and prepare journal entries and bank transfers for assigned entities
• Prepare and assist with audit and tax requests from external consultants
• Perform new client and vendor setup and accurately update existing records
• Analyze monthly financial statements and reports and perform variance analysis during month-end close
• Prepare and review lease and prepaid accounting schedules
• Manage fixed asset expenditures, transfers, disposals, depreciation, and amortization reporting
• Analyze billing-system reports, generate and send invoices, and prepare manual billings
• Monitor bank activity, record cash transactions, and research customer accounts and past-due balances
• Run unclaimed property reports, generate state-required letters, and ensure compliance
• Process ACH payments for clients according to payment terms
• Provide financial support across assigned business functions and multiple Navitus entities

Accountant II

• Prepare, review and post journal entries
• Maintain and monitor general ledger account reconciliations; investigate and resolve reconciling differences
• Reconcile intercompany account balances and prepare journal entries and bank transfers for assigned entities
• Prepare and assist with audit and tax requests from external consultants
• Perform new client and vendor setup and accurately update existing records
• Analyze monthly financial statements and reports and perform variance analysis during month-end closing
• Prepare and review accounting schedules for leases and prepaids
• Assess depreciation and amortization schedules and manage fixed asset expenditures, transfers, and disposals
• Generate and evaluate depreciation reports for financial and tax reporting and distribute them to stakeholders
• Analyze billing system reports, generate and send invoices, and prepare manual billings when needed
• Monitor daily bank activity, record cash transactions, and research customer accounts and past-due balances
• Run unclaimed property reports, generate required state letters, research requirements, and ensure compliance
• Process ACH payments for clients consistent with payment terms

Clinical Operations

• Perform telephonic consultations with patients regarding specialty medication use and disease-state management
• Perform medication reconciliation, screen for potential drug interactions, and provide side-effect management recommendations
• Conduct high-volume product verification to ensure order accuracy before shipment
• Interpret prescriptions and contact prescribers and patients to verify prescription information
• Expedite order processing and meet department production metrics and service levels
• Resolve patient issues and support quality standards
• Verify prescriptions, maintain detailed transaction records, and submit third-party reimbursement claims
• Consult with physicians and nurses regarding pharmaceutical questions and advise on formulary and cost-effective therapies
• Monitor storage, distribution, and use of pharmaceuticals
• Document patient consultations and interventions in pharmacy software and/or EMR systems
• Provide oversight and quality assurance to pharmacy technicians
• Verify controlled-substance validity and prescription information entered into systems
• Coordinate new prescriptions, prescription transfers, and conversions to generic, biosimilar, or preferred drugs
• Answer clinical questions from patients, caregivers, and pharmacy staff
• Stay current with specialty pharmacy therapies, drug approvals, and disease-state treatment guidelines
• Document and report medication errors and support error reduction according to ISMP standards and pharmacovigilance requirements
• Contribute to quality management and continuous improvement activities
• Perform other duties as assigned

Pharmacist – Clinical Operations

Risk

• Develop and maintain IT policies, procedures, guidelines, and standards aligned with ITIL best practices.
• Work with application developers, business users, internal IT, and third-party vendors to improve performance, processes, and overall data health.
• Plan and implement policies and procedures to ensure systems run optimally and processes align with company goals, industry best practices, and regulatory requirements.
• Ensure all environments are managed and maintained to meet service level agreements.
• Evaluate IT controls related to access management, change management, incident response, and service management.
• Monitor IT governance processes and controls and recommend improvements to efficiency, effectiveness, and compliance.
• Identify process improvements and resolve recurring problems with technical and business leads.
• Report and address barriers to incident, service request, problem, and change management resolution.
• Coordinate incident response activities and corrective action reviews.
• Assess the impact of proposed changes on IT governance policies, procedures, and controls.
• Develop, maintain, lead, and communicate Major Incident Management processes and delivery.
• Perform other duties as assigned.

IT Governance Analyst

Account Executive

• Lead full strategic ownership of a highly complex book of business, including employer groups, health plans, and multi-consultant relationships.
• Direct client account strategy, including planning, execution, and ongoing refinement based on clinical trends, utilization data, and business insights.
• Maintain trusted executive-level relationships with clients, brokers, and consultants.
• Guide Quarterly Business Reviews (QBRs), including agenda setting, cross-functional preparation, pre-review planning, and delivery of customized insights and recommendations.
• Upsell value-added programs such as AGS, medical carveouts with Archimedes products, and clinical program offerings.
• Translate complex reporting, claims adjudication concepts, and clinical insights into actionable recommendations.
• Identify root causes of performance gaps across the end-to-end process.
• Resolve complex client issues independently using operational, contractual, and clinical knowledge.
• Mentor Account Executive team members through best-practice sharing, training materials, task forces, and workgroups.
• Support organizational goals by strengthening client partnerships, increasing adoption of value-added programs, aligning solutions with clinical, financial, and utilization trends, and supporting sustainable growth.
• Perform other duties as assigned.

Senior Account Executive

General

• Run and review volume forecasts, shrinkage analysis reports, headcount requirements, new hire/modified shift requirements, and average handle time analysis to ensure accurate scheduling
• Conduct and document routine data validation of WFM systems and reports
• Measure forecast accuracy on short-term and long-term bases and meet established forecast accuracy goals
• Schedule activities around forecasted contact patterns and keep activities current in the WFM system
• Notify affected parties when offline activities need to be rescheduled
• Adjust call routing when unusual call patterns exist to ensure service levels are met
• Manage multiple queues and skill groups
• Identify needs for departmental reports and submit enhancement requests through production
• Shadow staff to identify opportunities to reduce handle time and improve first-call resolution
• Document and assemble requirements for reports, charts, scorecards, dashboards, and forecasts
• Develop training materials and document policies and procedures
• Perform other duties as assigned

Workforce Management Specialist

Administration

• Administer technical processes supporting system price setups, electronic funds transfer, and remittance setups according to policy
• Ensure appropriate controls and oversight reporting across the end-to-end process
• Identify, define, and implement new process controls as needed
• Resolve pharmacy network pricing setup issues and research pricing inquiries
• Develop processes to import and export data from Navitus systems, including the Pharmacy Credential and Contracting database and NCRx
• Perform pharmacy network rate testing, analysis, and impact assessment
• Perform ongoing quality assurance of pharmacy network rates to mitigate incorrect claims adjudication
• Identify and escalate improper payments and 835 issues
• Maintain department detail work instructions and policies
• Monitor and report non-compliance relating to overpayments, transaction standard issues, and financial regulations
• Provide offset detail to pharmacies impacted in a recovery project before receipt of payment and remit
• Oversee applicable financial and metrics reporting, data dictionaries, inquiries, and audits
• Submit service requests for necessary network updates, audit networks for price change accuracy, monitor compliance with pharmacy provider contracts, set up electronic payments and remits, and respond to payment issue questions
• Make independent assessments to confirm compliance with contractual reimbursement obligations
• Perform other duties as assigned

Pharmacy Reimbursement Administrator

Analyst

• Oversee Navitus’ contractual pharmacy network reimbursement accuracy
• Independently assess compliance with contractual reimbursement obligations in Retail, Specialty, and Mail Order pharmacy agreements
• Review and monitor claims data
• Create and update procedures
• Audit networks for price change accuracy
• Monitor compliance with pharmacy provider contracts
• Communicate findings and work with applicable teams to remediate errors
• Interpret contractual terms, client network selections, and their operationalization in applicable systems
• Utilize Navitus’ adjudication system (NCRx) and contracting and credentialing databases (PC2), among other applications
• Analyze provider, client, and network performance for network development, quality control, and contractual compliance
• Create reports validating systems accuracy against Retail, Specialty, and Mail Order contractual terms
• Field, analyze, and resolve pricing-error inquiries from pharmacy providers, clients, auditors, and internal teams, focusing on root cause
• Develop and maintain controls and oversight reporting for contract pricing
• Identify, define, and implement new processes when controls are absent
• Conduct pharmacy network rate testing, chain audits, and impact assessments
• Submit service requests and recovery requests and engage applicable teams for system updates or changes
• Report contractual compliance activities and opportunities to the Provider Services team and cross-functional leadership
• Perform other duties as assigned

Pharmacy Contract Audit Analyst

Growth Marketing

• Evaluate and prioritize RFP opportunities
• Partner with Sales and cross-functional leaders to shape pursuit strategies that enhance competitive positioning, win probability, and alignment with growth strategy
• Lead end-to-end development of RFPs, RFIs, BAFOs, and retention proposals
• Manage proposal timelines, workflows, deliverables, and coordination across clinical, operations, finance, pricing, and other stakeholders
• Monitor and analyze proposal performance metrics, including win rates, cycle times, and quality outcomes
• Drive continuous improvement of proposal processes, tools, templates, and content libraries
• Establish and maintain proposal standards, best practices, and quality controls
• Strengthen manufacturer relationships and optimize pricing strategies
• Lead, coach, and develop a high-performing proposal team
• Oversee staffing, recruiting, onboarding, retention, knowledge sharing, and team capability
• Support project management activities including planning, tracking, reporting, and documentation
• Ensure adherence to compliance requirements, internal policies, and organizational standards
• Perform other duties as assigned

Senior Manager, Strategic Growth – Proposal Performance

• Provide patient education through telephonic consultations for specialty pharmacy patients
• Assess and communicate disease-state management, side-effect mitigation, medication administration, storage, and therapeutic appropriateness
• Answer clinical questions from patients and caregivers
• Document patient consultations and interventions in the pharmacy software system
• Interpret and clinically evaluate specialty medication prescriptions
• Contact providers and patients to verify prescription information and expedite order processing
• Verify and confirm controlled-substance validity
• Contact physicians for new prescriptions and consult with physicians and nurses on pharmaceutical questions
• Contact pharmacies for prescription transfers
• Work with physicians to convert prescriptions to generic, biosimilar, or preferred drugs when possible
• Verify prescription information entered by order entry
• Answer clinical questions from the pharmacy team
• Adapt to new workflows and solve unique pharmaceutical problems
• Stay current with specialty pharmacy therapies, new drug approvals, and disease-state treatment guidelines
• Back up other pharmacists and train less experienced pharmacists
• Document and report medication errors
• Facilitate medication-error reduction and prevention methods based on quality department and ISMP standards
• Comply with applicable federal and state laws and ethical standards
• Perform other duties as assigned

Bilingual Pharmacist, Clinical Consultation – Specialty Pharmacy

Account Manager

• Develop and maintain trusted advisor relationships with existing customers and stakeholders to enhance customer experience and retention.
• Support complex, high-profile, and strategic books of business.
• Collaborate with internal stakeholders and external vendor partners to deliver customer service and benefit solutions efficiently and effectively.
• Mentor and train Account Manager team members by sharing best practices, producing training materials, and leading internal task forces or workgroups.
• Develop and maintain onboarding materials, job aids, checklists, detailed work instructions, and process guides.
• Facilitate or participate in client meetings to resolve open action items and provide status updates.
• Drive internal resolution of open action items.
• Facilitate benefit changes for clients and provide implementation direction.
• Analyze new or revised client requirements for accuracy and feasibility.
• Respond to client inquiries, issues, and concerns.
• Make decisions regarding resolution of member and client issues.
• Provide clients with system support and collaboration tools.
• Mentor Account Managers and new hires and assist with training activities.
• Participate in conference calls, meetings, and occasional travel outside normal business hours.
• Perform other duties as assigned.

Senior Account Manager

Director

• Own pharmacy network financial performance across all lines of business.
• Achieve contracted reimbursement guarantees, including effective rate (BER/GER) performance and MAC pricing outcomes.
• Lead the Network Reconciliation and MAC Pricing teams.
• Validate pharmacy network performance against contracted effective rates and pricing guarantees.
• Own reconciliation outcomes, financial settlement, and alignment to contract terms.
• Establish and enforce processes to monitor, measure, and report network performance against contractual targets.
• Identify performance variances and drive corrective actions with Network Contracting and Pricing teams.
• Ensure audit readiness, financial transparency, and governance across reconciliation activities.
• Oversee pharmacy network performance across effective rate, MAC, NADAC, PAC, and flat AWP pricing constructs.
• Lead development, maintenance, and performance of enterprise MAC pricing.
• Monitor claim-level reimbursement performance for outliers and pricing inefficiencies.
• Drive MAC adjustments for performance gaps, market changes, and provider behavior.
• Partner with Network Contracting, Underwriting, Finance, and Analytics leadership.

Director, PBM Network Pricing – Market Planning

Paralegal

• Manage licensing processes for Navitus, Archimedes, subsidiaries, and their employees
• Conduct legal searches on relevant laws, statutes, and regulations and prepare memorandums of findings
• Prepare legal documents, contracts, and correspondence for attorney review, approval, and use
• Manage document templates and corporate legal records
• File and index legal documents and correspondence in digital and physical filing systems
• Research and analyze statutes, judicial decisions, legal articles, contracts, and legal codes
• Perform clerical duties including scheduling appointments, providing information to stakeholders, taking notes, writing and typing routine correspondence, and triaging incoming mail
• Identify, review, and track legislative and regulatory environment changes impacting Navitus and its affiliates
• Provide support and guidance related to interpretation of applicable rules and regulations
• Support integration of Navitus and SSM Health values in Continuous Quality Improvement activities
• Perform other duties as assigned