The Supervisor, UM Configuration will have ownership and oversight of assigned Prior Authorization (PA) utilization management tools and/or forms. In coordination with the Manager, UM Configuration the Supervisor will develop and maintain the long-term and immediate roadmap for their PA product. The Supervisor will gain an industry understanding of their assigned product, understand Navitus’ current state and improve this product for internal and external benefit. The Supervisor will interface with clients and internal stakeholders to understand needs and areas for improvement. The Supervisor will understand Navitus’ cost on our PA product, its profitability, as well as competitiveness within the marketplace.
Additionally, the Supervisor will manage a team in their day-to-day tasks and responsibilities, provide supervision and leadership to staff to ensure the optimal use of resources for daily operations. The Supervisor will design and administer metrics, checks and balances, and quality programs that will ensure the integrity and quality of their designated PA product/program.
• Supervise non-clinical team which may include Testers, Analysts, and/or Sr. Analysts.
• Create and maintain training instructions for all roles. Train new team members on the PA utilization management product/program.
• Oversee the setup and maintenance of designated PA system configuration and testing.
• Act as product owner for assigned Navitus’ PA program.
• Develop and maintain the long and immediate-term roadmap for assigned systems.
• Ensure automated prior authorization continues to function as intended and is scalable to Navitus’ clients. Increase awareness of this program with select Navitus clients and expanding the program to those clients.
• Coordinate enhancement efforts and user test enhancements as they are implemented.
• Create and maintain an onboarding process for clients acquiring the program.
• Analyze and report on program specific data associated with these products.
• Enhance current program audit capabilities to ensure best-in-class program quality and integrity.
• Stay apprised of industry best practices and competitive intelligence and guide Navitus’ products to be an industry leading solution.
• Be an internal subject matter expert and point of contact on this product and work with cross-functional teams to enhance, train, and explain the benefits of the product.
• Work closely with Clinical PA Operations, Formulary Operations, Client teams, and Government Programs to ensure detailed requirements are met and execute goals of PA program.
• Lead process improvement, cost reduction and automation efforts. Independently assesses future business needs and brings recommendations to leadership.
• Meet and directly work with external clients and teams to be a subject matter expert and answer all questions related to the PA program and the benefits of the product.
• Education: Bachelor’s degree in a science, business, or mathematics related field, or equivalent work experience is required.
• Certification/Licenses: CPhT certification is preferred.
• Experience:
o Experience with prior authorization or PBM knowledge required.
o Experience with system support, enhancements, testing and a track record of tangible success is required.
o Experience in product management, formal/informal leadership and team collaboration/relationship-building/management is essential.
o Experience with program audits and quality is preferred.
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