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Due to growth we are adding a Sr. Software Engineer, Data Governance to our team!
The Sr. Software Engineer, Data Governance will help with the implementation and ongoing development of our Collibra Data Intelligence Cloud (DIC) and Collibra Data Quality & Observability platforms. This role will be responsible for the implementation of the Enterprise Data Governance Strategy of data cataloging/metadata management and data quality development within the Collibra DIC and Data Quality & Observability platforms, which will ensure trusted, high-quality data is available across Navitus.
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Navitus Health Solutions is seeking a Coordination of Benefits Product Manager to join our team!
The Product Manager, Coordination of Benefits is responsible for the development, administration, maintenance, and oversight of the COB Program. The Product Manager will ensure that the appropriate software, processes, procedures, and oversight monitoring are implemented and operational to meet changing COB program needs. The Product Manager, Coordination of Benefits will work closely with members of the following departments: Analytics, Benefit Systems, Claims Adjudication Development, Client Services, Compliance, Data Services, Government Programs, Implementation, and Member Service, ensuring COB is administered and maintained according to industry, state, federal,...
Navitus Health Solutions is seeking a Sr. Manager, Clinical Account Executive to join our team!
The Sr. Manager, Clinical Account Executive is a highly motivated professional with at least 5 years of successful clinical experience interfacing directly with large complex clients. This key position is responsible for leading and developing Clinical Staff within the Account Management department as well as the co-development of long-term account strategy for the Clients assigned to the team they support. The SMCAE has exceptional clinical, business and relationship building skills and possesses the ability to apply sound clinical judgment to a...
Due to growth we are adding a Provider Services Manager to our team!
The Manager, Provider Services is responsible for the oversight for executing contracts, credentials or payment setups with pharmacies, responding to pharmacy inquiries and completing the tactical and operational tasks required to maintain contracted pharmacy networks. The individual will ensure information contained in Navitus’ contract management systems are accurate and up to date. The individual(s) in this position will oversee end to end operational aspects of administration, analysis, and quality assurance for credentials and network design and management through...
Navitus Health Solutions is seeking a Manual Claims Coordinator to join our team!
The Coordinator, Manual Claims 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. This position is responsible for processing of pharmacy and/or direct member reimbursement (DMR) claims of all levels of complexity to execute the claims adjudication process including correction of claims.
The Coordinator, Manual Claims will manage the day-to-day processes and changes made to a...
As a key member of the Enterprise Architecture team, you will help shape the strategic vision of our technology ecosystem. Your role is critical in aligning both on-premises and AWS cloud infrastructure with enterprise applications to support long-term business objectives. You will ensure that every system, process, and platform is architected for scalability, resilience, and innovation.
Your ability to design and deliver enterprise-grade solutions will directly impact our customers by enabling seamless, secure, and future-ready technology experiences. Prior experience in solutioning and developing enterprise-scale architectures is highly valued and will contribute to your success in this role.
Due to growth we are adding a Coordinator, Training and Development to our team!
The Coordinator, Training and Development (TC) will deliver highly interactive, engaging, and impactful virtual instructor-led, instructor-led, web-conferenced, and video-conferenced training opportunities. The TC will support the ongoing efforts such as facilitating new hire orientations; coordinating, scheduling, and assisting ongoing training initiatives; resource and knowledge management; and regular marketing of the learning function. This person will utilize the corporate learning management system (LMS) to assign training and measure training success. This...
Due to growth we are adding a Prior Authorization Specialist to our team!
Under direction from the Supervisor, Specialty Pharmacy Services, and pharmacists in the Specialty Pharmacy, the Prior Authorization Specialist I is primarily responsible for obtaining information and assisting providers and insurance companies in triaging prior authorizations for patients of the specialty pharmacy. The Prior Authorization Specialist’s main objective is to answer phone calls and contact the doctors and patients via fax or phone or other communication means to facilitate and document prior authorization approval. The Prior Authorization Specialist...
Due to growth we are adding an Intake Specialist to our team!
Under direction from the Assoc. Manager, Patient Support Services and pharmacists in the Specialty Pharmacy, the Intake Specialist I is primarily responsible for enrolling new Specialty Pharmacy patients and ensuring that all pertinent patient information is contained within the record. Patient information shall include demographics, allergies, medication history, comorbidities, and payer information. The Intake Specialist I’s main objective is to place phone calls to new and existing patients, answer phone calls and contact the doctors and patients via fax or phone or other communication means. The Intake Specialist I is also responsible...
Due to growth we are adding a Analyst, Pricing and Underwriting to our Finance Administration department!
The Analyst, Pricing and Underwriting
Navitus Health Solutions is seeking a Reimbursement Analyst, Pharmacy Network to join our Provider Services department!
The Analyst supports and evaluates agreements with providers and the Maximum Allowable Cost (MAC) program through financial price modeling, analysis, and reporting. This position will communicate and work cross functionally with other teams on generic trends and generic drug discount change effects. Provider and network performance will be analyzed in support of network development, contracting negotiations, and RFP proposals. The Analyst, under the direction and supervision of the Provider Services leadership, is responsible for maintaining a competitive and...
Navitus Health Solutions is seeking a Sr. Client Services Executive I to join our Contract Performance Management department!
Due to growth, we are adding a Sr. IT Business Relationship Manager to our IT Management department.
Due to growth, we are adding a Sr. IT Business Relationship Manager to our IT Management department.
Due to growth, we are adding a Sr. IT Business Relationship Manager to our IT Management department.
Due to growth, we are adding a Sr. Paralegal to our Legal & Regulatory Affairs department.
Due to growth, we are adding a Engineer, Data Integration to our Data & Digital department.
The...
Due to growth, we are adding a Team Lead, Account Management to EpiphanyRx.
As a Team Lead, Account Management, you...
Lumicera Health Services is seeking a Prior Authorization Specialist to join the team!
Under direction from the Supervisor, Specialty Pharmacy Services, and pharmacists in the Specialty Pharmacy, the Prior Authorization Specialist I is primarily responsible for obtaining information and assisting providers and insurance companies in triaging prior authorizations for patients of the specialty pharmacy. The Prior Authorization Specialist’s main objective is to answer phone calls and contact the doctors and patients via fax or phone or other communication means to facilitate and document prior authorization approval. The Prior Authorization Specialist may also be responsible for ensuring that all pertinent patient information is contained within the record....
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 Earth City, MO 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
Due to growth, we are adding Benefit Configuration Trainer to our team!
The Trainer, 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 Trainer, Benefit Configuration facilitates and completes the new hire training program within CAO. This position requires knowledge of both the technical and operational sides of the business utilizing Navitus’ adjudication system and other applications.
The Trainer, Benefit Configuration will closely collaborate with CAO coaches...
Due to growth, we are adding a Utilization Management Analyst to our Prior Authorization department!
The Analyst,
Lumicera Health Services is seeking a Patient Care Assistant to join our team!
Under general direction of the Supervisor, Pharmacy Services the person employed in this Patient Care Assistant/ Customer Service position will assist with the Specialty Pharmacy programs. Primary responsibility is to effectively communicate with patients, physicians, pharmacists, and payers to assist in the fulfillment and patient care of specialty pharmacy medications in a Specialty Pharmacy.
The Patient Care Assistant focuses on answering and placing calls with a warm and professional greeting with patients, prescribers, and insurance companies. This role must accurately gather relevant information for the prescription fulfillment process. This position must be able...
Navitus Health Solutions is seeking a Lean Portfolio Manager, EPMO to join our team!
The Lean Portfolio Manager, EPMO is a highly collaborative role responsible for managing portfolio epics and developing business cases. The Lean Portfolio Manager, EPMO partners with key stakeholders to identify, define, and refine epics and to articulate value and benefits to the organization. Additionally, the Lean Portfolio Manager, EPMO will guide epics through the various stages of Portfolio Management and partner with Release Train Engineers, Enterprise Architecture, Business Leads, and agile delivery teams to initiate the development activities...
Archimedes is a specialty medical management company with an industry-leading technology platform that client groups can use to manage specialty medical spend. We are looking for an experienced Sr Software Developer to join our technology team.
Archimedes is a specialty medical management company with an industry-leading technology platform that client groups can use to manage specialty medical spend. We are looking for an experienced Sr Software Developer to join our technology team.
This is a hybrid position in Madison WI at least three days a week.
Due to growth, we are adding a Paralegal to our Legal and Regulatory Affairs department!
This Paralegal role will report to the Assistant General Counsel -Contracts and support in drafting contracts and other legal documents for Navitus Health Solutions, LLC and its Subsidiaries. This role may also support Navitus, Lumicera, and their subsidiaries by (a) managing licensing processes; (b) drafting legal documents and templates, managing document templates and corporate legal...
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 rebate submission...
Based on our rapid growth, we are expanding our PBM operations team at an exciting time in our history. Archimedes is looking for a person with a passion for helping plan sponsors control the cost of drugs through an aligned business model, value-based coverage, data-driven solutions, and innovative technologies. Given our continued growth trajectory, we are looking for an experienced healthcare operations leader who can grow with the company’s core operations and lead the expanding team in a hybrid role working onsite 3 days per week.
The Associate Director – Operations will be responsible for managing the ongoing operations team for claims, eligibility and accumulators as well as...
Due to growth, we are adding Client Onboarding Advisor - Pharmacy Network Management to our Pharmacy Network Operations department!
The Client Onboarding Advisor will play a key role during new client implementations to understand the client’s current processes, requirements and goals and will cross reference these to Navitus’ product offerings to strategize on how to meet the client’s needs. This individual is responsible for the creation and execution of onboarding plans created specifically for the client and will oversee the entire onboarding process end-to-end for their functional area. The Client Onboarding...
Due to growth, we are adding Systems and Quality Analyst Manager to our team.
The Systems and Quality Analyst Manager will provide support for the development, implementation, and maintenance of our FFS Medicaid products. The FFS implementations require full compliance...