Navitus

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

USD $98,383.84 - USD $114,934.37 /Yr.

M-F: 8AM-5PM CST

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Due to growth, we are adding a Sr. Quality Improvement Consultant to our Team!

 

The Sr. Quality Control & Improvement Consultant is an integral part of the Claims Quality Assurance & Testing (QAT) team which performs multiple functions in quality control and quality improvements with a goal to ensure the accuracy of benefit plan configuration in the NavicareRX system for the entire enterprise. They are responsible for ensuring that internal process adherence is met for all lines of business and all departments. This position will be responsible to partner with business partners and implement a work management tool that feeds information to the Claim Adjudication Operations teams. The QAT team reviews the client’s requirements at implementation to determine client intent and audit approach to gain the expected outcome. This position will collaborate with the Implementation, Account Management, Compliance, and IT teams. This position will utilize system expertise, client documentation, claim adjudication rules, and QAT team processes and procedures to effectively identify coding errors and identify trends to improve processes. This position will be responsible for creating a heat map, identifying quality gaps, and recommending and implementing process improvements across the enterprise. The position will be responsible for working with the IT Teams to develop/enhance new automation tools. The position will be responsible for initiating process improvements, root cause analytics, preventative action implementation, metrics, automation, training, documentation, and compliance.

 

Is this you? Find out more below!

How do I make an impact on my team? 

What our team expects from you?

• College degree or work experience equivalent
• 10+ years of relevant work experience in the healthcare industry or demonstrated expertise with benefit configuration and testing
• Expert level experience using MS Excel filtering, sorting, and analyzing data with ability to write complex Excel formulas
• Minimum eight years of experience in leading and implementing process improvement initiatives
• Minimum eight years of experience in the health care industry, or equivalent
• Knowledge and demonstrated experience with usage of industry standard tools for managing projects and quality improvement initiatives
• Experience in creating a heat map and identifying quality gaps for an entire enterprise
• Minimum 8 years’ experience in a client facing role with the ability to articulate the PBM process and answer client questions related to quality controls
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus? 

• Top of the industry benefits for Health, Dental, and Vision insurance 
• 20 days paid time off 
• 4 weeks paid parental leave 
• 9 paid holidays 
• 401K company match of up to 5% - No vesting requirement 
• Adoption Assistance Program 
• Flexible Spending Account 
• Educational Assistance Plan and Professional Membership assistance 
• Referral Bonus Program – up to $750! 

#LI-Remote

Remote

US