WI3662025

1

Bachelor's Degree

Bachelors Degree

$70692 + yearly

Unspecified

40

JOB REQUIREMENTS: 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. Due to
growth, we are adding this Manager, Auditing and Testing to our Provider
Services department. We are 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. The Manager, Auditing and Testing will oversee and manage a
team of analysts. This position is responsible for the oversight of
pharmacy contract claims accuracy and audits of the pharmacy system.
This position will support the Navitus Provider Services, Account
Management, Government Programs, Legal and CAO departments to facilitate
the successful monitoring and evaluation of our pharmacy networks and
implementation of necessary system updates. This individual will be
expected to understand, interpret, analyze, and integrate data,
including claims utilization of current clients, the Navitus claims
adjudication system, pharmacy network databases, NCPDP pharmacy files,
and other databases from time-to-time. Is this you? Find out more below!
How do I make an impact on my team? Responsible for the career
development and training of Pharmacy Audit and Testing Team.
Collaborates with operational departments, identifies and implements
appropriate changes in operating procedures and systems that might be
required to accommodate PBM contracts. Acquires and maintains a thorough
understanding of all implications of adjudication platform changes while
coordinating accordingly with all upstream and downstream stakeholders.
Initiates and assists coordination within internal teams, such as,
Client Services and BCA, in order to improve efficiency, accuracy, and
capacity of the adjudication platform functionality. Participates in and
supports all external delegation and financial audits of the pharmacy
network pharmacies. Responsible for all quality reviews of the data
within pharmacy network database. This includes the claims processing
system and any other tool that utilizes data related to the pharmacies.
Generate reports on network performance to share with Senior Leadership.
Ensure compliance with legal and compliance requirements for network
pricing Develop or enhance systems to house Navitus network pharmacy
databases. Oversees and addresses all aspects of maintenance related to
pharmacy network functions, such as,\... For full info follow
application link. Navitus Health Solutions is an Equal Opportunity
Employer: Disabled/Veterans/Male/Female/Minority/Other \*\*\*\*\*
APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/DC7C77BC57064777