Navitus

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.

The Specialist I, Prior Authorization (PAS) will review, process, and troubleshoot incoming Prior Authorization requests for various medications, accurately processing the requests according to regulatory and client specific guidelines. The PAS will work with team members to meet departmental performance metrics, maintain compliance, and work with clinical teams to ensure timely and accurate request processing via phone, fax, and web submission.

The Rebate Account Specialist II analyzes and implements PBM to GPO and pharmaceutical manufacturer rebate submission and reconciliation processes, working closely with the Manager of Rebate Operations to ensure timely audit of eligible claim data for rebate invoicing.

Due to growth, we are adding a Data Integration Developer to our team! You will have a background in data integration technologies and an understanding of database systems, ETL processes, and data warehousing concepts. You 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.

The Developer II, Application Systems ensures efforts are in alignment with IT Enterprise Services to support customer-focused objectives. This role is responsible for development support, design, programming, and implementation of custom processes within the framework of various enterprise systems. The role will also drive citizen development with the application framework and work directly with business users to develop requirements ensuring the business needs are met.

The Analyst 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 adjudicate accurately and timely. The Analyst must use sound business judgement and demonstrate the ability to continually prioritize tasks.