The Specialist I, Prior Authorization (PAS) will review, process, and troubleshoot incoming Prior Authorization requests for various medications. The Specialist I, Prior Authorization (PAS) will accurately process the requests according to regulatory and client specific guidelines. The PAS will work with other team members to meet the departmental performance metrics and maintain compliance. The PAS will work with clinical to ensure requests are processed accurately and timely. The PAS will process requests that come in via phone, fax, and web submission.   Is this you? Find out more below!

This is a hybrid configuration role working 2-3 days per week at our corporate campus located at 361 Integrity Dr, Madison, WI 53717 and 2-3 days per week from home. A remote working configuration is not being considered for this role at this time.   Navitus Health Solutions is seeking a Sr. Analyst, Revenue Cycle Management to join our Accounting department!   The Sr. Analyst, Revenue Cycle Management is responsible for supporting client onboarding and ongoing contract administration of the Navitus Clients best-in-class billing and analytics systems and processes.  The primary goal of this role is to ensure revenue capture is accurate and timely with emphasis on reducing manual...

Navitus Health Solutions is seeking a Analyst, Benefit Configuration to join our CAO Client department!   The Analyst, Benefit Configuration ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. The Analyst, Benefit Configuration configures benefits in the claim adjudication system based on specifications from internal customers and external clients. This role applies knowledge of highly diverse plan designs, formularies, and networks across multiple lines of business, ensuring that claims...

Due to growth, we are adding a Clinical Outcomes Analyst to our Clinical Program Management Team!   The Analyst, Clinical Outcomes is a role that brings together theory and practice to identify and communicate data-driven insights that allow managers, stakeholders, and other executives in the organization to make informed decisions. The Analyst, Clinical Outcomes will have a general understanding of the company’s databases, business intelligence (BI) tools, and existing reports and act as a resource in...

Navitus Health Solutions is seeking a Formulary Operations Specialist to join our Team!   The Specialist, Formulary Operations will perform the daily, weekly, and monthly/periodic administrative functions necessary to update and maintain the formularies for Navitus’ clients for all lines of business. This includes working with the Formulary Services Supervisors to make all changes to the formulary information accessed by clients, as well as day to day formulary maintenance; and having advisory input to how this information is presented, maintained, and...

Due to growth, we are adding a Medicaid Pharmacist to join our team!   The Pharmacist, Medicaid is responsible for providing Medicaid clinical, operational, and educational support to Navitus teams. This position will serve as a subject matter expert for Medicaid clinical aspects. The Pharmacist, Medicaid will provide operational support for the delivery of Medicaid clinical information to various business units throughout Navitus, interpretation of Medicaid guidance and state regulations, and support of Medicid clinical operation processes. This position will be an active member of the Government Clinical Services Team within the Health Strategies Division. The ability to...

Lumicera Health Services is seeking a Business Intelligence Developer to join our IT Management department!   The Business Intelligence Developer brings together theory and practice to identify and communicate data-driven insights that allow managers, stakeholders, and other executives in the organization to make informed decisions. The Business Intelligence Developer will have an intermediate understanding of the company’s databases, business intelligence (BI) tools, and existing reports and act as a resource in internal and external meetings. A good candidate will be detail oriented, analytical, a skilled communicator, and a quick learner with experience in analytics, data modeling, or business intelligence.   Is this you? Find out more...

The Referral Coordinator will assist in processing all inbound specialty prescriptions from referring prescribers. They are tasked with coordinating and assuring the smooth flow of the prescription referral and prior authorization process to meet the needs of patients while establishing collaborative relationships and communication with the prescriber’s office.   Is this you? Find out more below!

The Application Systems Developer role ensures efforts are aligned with IT Enterprise Services to support customer-focused objectives and the IT Vision, a collaborative partner delivering innovative ideas, solutions and services to simplify people’s lives. This role is responsible for development support, design, programming and implementation of custom processes within the framework of various enterprise systems using Microsoft Power Platform to enable Robotic Process Automation. This role will also drive citizen development with the application framework. This individual will work directly with business users to develop requirements ensuring the business needs are met.  

Due to growth, we are adding a Data Integration Developer to our team!   The Developer, Data Integration will have a background in data integration technologies and an understanding of database systems, ETL (Extract, Transform, Load) processes, and data warehousing concepts. The Developer, Data Integration will collaborate with cross-functional teams to design, develop, test, and implement data integration solutions that meet business requirements and ensure data accuracy and integrity. This position will report to the manager of Data Services. The Developer, Data Integration ensures efforts are in alignment with the Data Services team to...

The Clinic Services Executive (CSE) is a highly motivated professional with at least 5 years of successful experience interfacing directly with varied complex customers preferably in healthcare, to manage existing physician and prescriber clinics and health systems. The position is responsible for the co-development of long-term account strategy for their assigned clinics. Working with Referral Coordinators, the CSE will be for responsible for identifying expansion opportunities and communicating these opportunities appropriately to be incorporated into the annual strategic business plan. The CSE will be responsible for clinic retention, achieving corporate strategic goals relative to client base, and overall customer satisfaction,...

Due to growth, we are adding a Lead, Business Systems - eZBenefits to our Implementation Team!   The Lead, Business Systems is the business owner of the CRM Dynamics 365 or eZBenefits, eZSurv or equivalent systems and is responsible for the implementation and advancement of strategies, plans and systems that align with our overall business...

Navitus Health Solutions is seeking a Supervisor, Rebate Operations to join our team! The Supervisor, Rebate...

Navitus Health Solutions is seeking a Rebate Account Specialist II to join our Rebate Operations department!   The Rebate Account Specialist II is responsible for analyzing, understanding and implementing PBM to GPO and pharmaceutical manufacturer rebate submission and reconciliation processes. This individual will work closely with the Manager of Rebate Operations to ensure complete, accurate and timely audit of eligible claim data for rebate invoicing. In addition, the Rebate Account Specialist II will work with the IRC Contracting/strategy team to ensure...

The Trainer, Learning and Development will deliver highly interactive, engaging, and impactful virtual and in person instructor-led, and video-conferenced training to employees at all levels of the organization. Training topics will include interpersonal and leadership skills, which will necessitate a high level of emotional intelligence on the part of the Trainer. Responsibilities will also include completing the tactical and operational tasks required to meet the training needs of learners and Learning Services team members. The Trainer will use the corporate Learning Management System to schedule, share and document training and evaluate training effectiveness. The Trainer will also conduct training needs assessment, as well as analysis, design, development,...

Navitus Health Solutions is seeking a Telehealth Pharmacy Technician to join our CEC Operations department!   This position will have the opportunity to impact patient’s health every day via the delivery of best-in-class interventions and patient care. Working with pharmacists, nurses and a supportive leadership team, the Telehealth Pharmacy Technician (CPhT) is responsible for aiding in the delivery of clinical interventions and Medication Therapy Management (MTM) services for commercial and Medicare members. The MTM program will include telephonic and/or video chat outreach with members to complete an analysis of a member’s medication regimen.  

The Call Center Team Lead will assist the Call Center Supervisor in managing the performance of the call center to meet established SLA's in addition to assisting with both Inbound and Outbound calls. A deep understanding of Archimedes’ culture and mission is vital to the success of this position. 

Navitus Health Solutions is seeking an FF Medicaid Technology Manager to join our IT Development department!   The Technology Manager ensures the streamlined operation of the FFS Medicaid Technology team in alignment with the customer-focused objectives and the IT Vision; a collaborative partner delivering innovative ideas, solutions, and services to simplify people's lives. This individual will plan, design, coordinate and align resources to support the daily activities of the team. The Manager will work closely with customers and decision makers to identify, recommend, develop, implement, support, and improve technical solutions for the FFS...

Due to growth, we are adding a Principal, Product Strategy - Health Plan to our Enterprise Product Strategy department within the Growth Division!   The Principal, Product Strategy is responsible for guiding the strategic direction and execution of disciplined, enterprise-aligned product design, development, go-to-market, and governance initiatives. This forward-thinking leader will execute with excellence, influence cross-functional stakeholders, drive innovation, and ensure connection between market-solutioning initiatives and the organization’s...

Navitus Health Solutions is seeking a Market VP, Sales to join our team!   The Market VP, Sales will manage the entire scope of the sales process for new Navitus Health Solutions National Accounts business in the following markets: Employer, Government, Labor (municipal, Taft-Hartley), and Self-funded companies. The Market VP, Sales will work with Executive Sales leadership to develop and execute market strategies for these market segments. The Market VP, Sales is responsible for all phases of the sales process through finalist presentation and signed contract....

Archimedes is a specialty drug management company with industry-leading technology and services that health plans and employer groups can use to manage specialty drug spend. We are expanding our team and looking for a clinical professional who has specialty drug management experience and a passion for cost management. Given our continued growth trajectory, we are looking for a person who can grow with the company.   This role will be divided into two areas: external clinical outreach activities related to high-cost case management and prior authorization of specialty medications, across pharmacy and medical benefits and specialty and traditional drugs. In...

Navitus Health Solutions is seeking a IT Support Technician to join our team!   The IT Support Technician will be responsible for providing first level technical assistance and support related to computer systems and hardware. Respond to queries, execute basic diagnostic programs, isolate problems, and determine proper escalation within Navitus and/or vendor support. Individuals in this job position are competent to perform work at the entry level technical skill set within this job family. They have some familiarity with information technology systems and...

Navitus Health Solutions is seeking a Supervisor, Clinical Engagement Center (RPh) to join our team!   The Supervisor, Clinical Engagement Center (RPh) is responsible for leadership and support of a cross functional team of associates within the CEC.  This role will also have expanded responsibility for select clinical functions as assigned by their manager. This may include, but is not limited to, quality improvement initiatives, auditing, creation and maintenance of detailed work instructions, new program development, collaboration with additional Navitus teams...

Navitus Health Solutions is seeking a Supervisor, Claim Adjudication Operations to join our CAO Client department!   The Supervisor, Claim Adjudication Operations ensures the streamlined operation of the Claim Adjudication Operations team in alignment with customer-focused objectives. This individual will plan, design, coordinate and align resources to support the daily activities of the team. The supervisor will work closely with their team to identify, recommend, develop, implement, support, and improve customer-focused solutions.

Lumicera Health Services is seeking a Pharmacy Technician at our Madison Facility!   Under direction from the Pharmacist-in-Charge and other pharmacists in the Specialty Pharmacy, the Pharmacy Technician I is primarily responsible for assisting the pharmacist in obtaining all the necessary information for dispensing and adjudicating a medication correctly. The Pharmacy Technician I’s main objective is to answer phone calls and contact the doctors and patients via fax or phone or other communication means. The Pharmacy Technician I is also responsible for accurately translating prescription information and all other information obtained to dispense the medication into the pharmacy...

Archimedes is a specialty drug management company with an industry-leading technology platform that health plans and employer groups can use to manage specialty drug spend. We are expanding our team and looking for a self-motivated project management professional who has specialty drug management experience and a passion for cost management. Given our continued growth trajectory, we are looking for a motivated project manager who can grow with the company to buildout and lead large projects. The successful candidate will work directly with clients to ensure deliverables fall within the applicable scope, timing and budget. We are looking for a creative and dedicated individual who will fit with...

Navitus Health Solutions is seeking a Sr. Proposal Analyst to join our Proposal Department!   The Sr. Analyst, Proposal role is critical to the client acquisition and retention efforts of Navitus Health Solutions. This position works cross-functionally at a variety of levels to maximize sales and retention through the timely creation and management of competitive responses to Requests for Proposals (RFPs) and other sales related documents for a variety of audiences. The Sr. Analyst, Proposal ensures agreed upon strategies are incorporated into persuasive,...

Navitus Health Solutions is seeking a Sr. Solutions Architect to join our IT Development team!   The Sr. Solutions Architect ensures efforts are in alignment with the IT FFS (Fee for Service) Medicaid Technology team to support customer-focused objectives and the IT Vision: a collaborative partner delivering innovative ideas, solutions, and services to simplify people’s lives. The Sr. Solutions Architect is responsible for driving the software architecture and platform of our AWS Cloud-based ecosystem. The Sr. Solutions Architect will define the technical end-to-end architectures needed to support the strategic direction of the FFS Medicaid line of business.   Is...

Lumicera Health Services is seeking a Pharmacy Technician to join our Specialty Pharmacy Operations team!   Under direction from the Pharmacist-in-Charge and other pharmacists in the Specialty Pharmacy, the Pharmacy Technician I is primarily responsible for assisting the pharmacist in obtaining all the necessary information for dispensing and adjudicating a medication correctly. The Pharmacy Technician I’s main objective is to answer phone calls and contact the doctors and patients via fax or phone or other communication means. The Pharmacy Technician I is also responsible for accurately translating prescription information and all other information obtained to dispense the...

Navitus Health Solutions is seeking a Software Engineer to join our IT Development department!   The Software Engineer position ensures efforts are in alignment with the Information Technology team, to support customer-focused objectives and the IT Vision, a collaborative partner delivering innovative ideas, solutions, and services to simplify people's lives. They will serve in a more seasoned capacity, within the team and will collaborate with the business teams to prototype new technologies and recommend solutions. This role will be involved with research,...

Archimedes is a rapidly growing leader in the specialty drug benefit management space.  We are looking for a Member Services Representative to work on-site in our Brentwood, TN office.  This position is responsible for delivering excellent service to members utilizing processes and technology within a call center.  If you are reliable with strong problem-solving and customer service skills, we would love to hear from you

Navitus Health Solutions is seeking a SIU Analyst I to join our team!   The SIU Analyst position is responsible for conducting moderate to complex research using internal and external databases to perform analyses and develop recommendations on suspected fraud, waste, and abuse related to members, prescribers, pharmacies, and clients. In addition, the Analyst is responsible for regular and proactive extraction and evaluation of mined data, scoping data for investigations, and responding with reports and data for audits, universes, and impact assessments. The Analyst will coordinate and support data requests from third parties regarding fraud,...

Navitus Health Solutions is seeking a Product Owner, IT to join our IT Delivery department! The Product Owner, IT will collaborate and facilitate value delivery. The Product Owner will play a critical role in partnering with Business Leads and the Portfolio to define, prioritize, and drive the development of product enhancements and large strategic initiatives. The Product Owner will work closely with a cross functional team to ensure that the value delivery aligns with the overall business objectives and meets customer needs.  Is this you? Find out more below!  

Under general direction of the Associate Manager, Pharmacy Services, the Supervisor, Specialty Pharmacy Support Services is responsible for managing the day-to-day operations of a team of Intake Specialists. This position monitors productivity and performance standards and plans and directs workflow and project assignments. Oversees production volume to ensure service standards are met. The Supervisor, Specialty Pharmacy Support Services will participate in hiring, training, and evaluation of staff, as well as be responsible for team’s adherence to corporate attendance and employment policies. This individual will work with the Associate Mgr, Pharmacy Service to develop policies, procedures, and the business work plan for the team...

Due to growth, we are adding an Accumulator Coordinator to our CAO Client department.     The Coordinator, Accumulator ensures efforts are in alignment with the Claim Adjudication Operations...

Due to growth, we are adding a Supervisor, Claim Adjudication Operations to our CAO Client department.    

Due to growth, we are adding an Accumulator Analyst to our CAO Client department.     The Analyst, Accumulator ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage...

Due to growth, we are adding a Coordinator, Operations Data to our CAO Implementation department. 

Navitus Health Solutions is seeking a Analyst, Tech. Operations Government Programs to join our team!   The Analyst, Tech. Operations Government Programs has responsibility for executing Government Programs processes accurately, efficiently, and in compliance with CMS regulations.   Is this you? Find out more below!

Due to growth, we are adding an Analyst, Historical Claims to our CAO Client department. 

Navitus Health Solutions is seeking a Med D Compliance Oversight Analyst to join our team!   This position is an Med D Compliance Oversight Analyst SME directly responsible for conducting internal and external audits and monitoring activities for the PBM Employer Group Waiver Program (EGWP) and MA-PD/MMP Health Plan audits. The Med D Compliance Oversight Analyst (COA) will conduct quality assurance review on all audit and monitoring results. The COA will be responsible for providing monthly/quarterly audit and monitoring reports to the internal...

Lumicera Health Services is seeking a Information Technology Manager to join our team!   The Manager, Information Technology ensures the streamlined operation of the Lumicera IT team in alignment with the customer-focused objectives and the IT Vision, a collaborative partner delivering innovative ideas, solutions, and services to simplify people’s lives. This individual will plan, design, coordinate and align resources to support the daily activities of the team. The manager will work closely with customers and decision makers to identify, recommend, develop, implement, support, and improve the customer-focused solutions.

Navitus Health Solutions is seeking s Sr. Software Developer to join our IT Development team!   The Sr. Software Developer ensures efforts are in alignment with the Information Technology team to support customer-focused objectives and the IT Vision, a collaborative partner delivering innovative ideas, solutions, and services to simplify people’s lives. The Sr. Software Developer’s role is to define, design, develop, test, analyze, and maintain new and existing applications in support of the achievement of business requirements. This includes designing, documenting, coding, testing, and analyzing software programs and applications. The Sr. Software Developer will also research, design, document,...

Navitus Health Solutions is seeking a Software Engineer to join our IT Development department!   The Software Engineer position ensures efforts are in alignment with the Information Technology team, to support customer-focused objectives and the IT Vision, a collaborative partner delivering innovative ideas, solutions, and services to simplify people's lives. They will serve in a more seasoned capacity, within the team and will collaborate with the business teams to prototype new technologies and recommend solutions. This role will be involved with research, design, development, testing and documentation of projects. They will be encouraged to...

Navitus Health Solutions is seeking a Supervisor, Prior Authorization Operations to join our Prior Authorization department!    The Supervisor, Prior Authorization Operations is responsible for organizing and supervising the daily operations of the prior authorization process and the prior authorization staff. The Supervisor, PAO is responsible for ensuring that formulary changes directed by the Pharmacy & Therapeutics Committee and changes driven...

Due to growth we are adding a Service Delivery Speacialist to our team!   Under direction from the Supervisor, Specialty Pharmacy Operations and the Pharmacist in Charge and/or Supervisor of Service Delivery, the Service Delivery Specialist is primarily responsible for the ongoing monitoring and carrier communication to help assure shipments deliver as intended. The Service Delivery Specialist’s objective is to use carrier or third-party resources at their disposal to quickly and efficiently resolve issues that may occur during shipment transit. The Service Delivery Specialist will be the primary point of contact for other members of the...

Lumicera Health Services is seeking a Specialty Pharmacy Intern to join our team!   The Specialty Pharmacy Intern will assist with customer service and clinical programs of Lumicera Specialty Pharmacy. The primary responsibility of this position is to effectively communicate with patients, physicians, pharmacists, and payers in the fulfillment and patient care of specialty pharmacy medications in a Specialty Pharmacy. Additionally, this person must have the ability to assess patient needs, consult on specialty pharmaceuticals and disease states, accurately set up orders and needed medication supplies. This role focuses on the clinical management...

The Tester, Benefit Configuration ensures efforts are in alignment with the Claim Adjudication Operations (CAO) team to leverage technology and process improvement for the purpose of meeting the business needs of Navitus customers, clients, members, and pharmacies by accurately administering benefits. The primary functions of the Tester, Benefit Configuration involve performing and documenting benefit configuration testing ensuring Navitus maintains an accurate, efficient, and versatile claims adjudication system. This position develops tactical tasks and processes to incorporate client and company initiatives into testing to ensure the integrity of pharmacy claims processing.   The Tester, Benefit Configuration will work closely with several Navitus roles and...

Due to growth we are adding a Specialty Implementation Project Manger to our team!   The Project Manager, Specialty Implementation (SIPM) is a highly motivated professional with at least 3 years of successful client implementation experience. The SIPM is responsible for leading the effort to implement new patients. This position oversees all aspects of the project planning, monitoring, and controlling processes. The SIPM is responsible for the coordination and completion of the implementation and to this end will perform a variety of tasks including setting deadlines, assigning responsibilities, monitoring, and summarizing project...

Due to growth we are adding a Quality Analyst to our team!   The Quality Analyst will be responsible for developing, implementing, and monitoring processes to obtain and audit key performance indicators. Through these processes and programs, the Quality Analyst will continually monitor the abilities, competencies, and service quality delivered by members of the teams and provide reports to area leaders of business and employee key performance indicators.   The Quality Analyst will monitor and audit inbound service calls to assess employee demeanor, technical accuracy, performance, and conformity to company policies and procedures.  The Quality...