Jobs at Navitus Health Solutions

Supports and maintains Navitus accreditation programs by interpreting standards, conducting audits, analyzing performance data, managing quality initiatives, coordinating accreditation surveys, and developing corrective action plans. Serves as a subject matter expert and liaison with accreditation organizations, clients, and internal stakeholders. Provides consultation and training, oversees quality management activities, maintains delegation agreements, and drives continuous improvement and accreditation readiness.

Configures pharmacy benefits in claim adjudication systems using client specifications, ensuring accurate and timely claims processing. Performs benefit updates, quality reviews, troubleshooting, testing, reporting, audits, and root cause analysis. Supports client meetings, implementations, process improvement, compliance, training, and mentoring while maintaining knowledge of plan designs, formularies, networks, and applicable standards.

Owns the Transformation Office operating system and enterprise transformation portfolio performance discipline. Leads governance cadences, executive reporting, accountability tracking, RAID and path-to-green management, integrated planning, risk escalation, and decision support. Partners with senior leaders, EPMO, Finance, Communications, Change Management, business owners, and technology teams to ensure transformation initiatives remain aligned, transparent, accountable, and on track.

Leads an assigned transformation value stream, overseeing portfolio execution health, strategic alignment, milestone delivery, financial visibility, risk mitigation, business readiness, and benefits realization. Coordinates business, technology, operations, finance, and customer-facing teams; translates enterprise priorities into executable plans; drives prioritization and accountability; assesses delivery confidence; and challenges scope, sequencing, and investments to maximize outcomes.

Leads enterprise continuous improvement initiatives involving process design, RPA, Lean Six Sigma, and DMAIC. Partners with business leaders to prioritize strategic projects, analyze current-state processes, define objectives and metrics, develop project plans, and deliver sustainable improvements. Coaches employees, promotes continuous improvement methodologies, manages stakeholders and milestones, and documents best practices. The role requires a bachelor’s degree or equivalent experience, Lean Six Sigma Black Belt certification, and at least five years of relevant experience.

Processes manufacturer copay assistance reimbursement, monitors and submits claims, verifies patient billing setup, resolves billing and claim issues, documents insurance and prescription information, and responds to reimbursement questions from employees, patients, and clients. The role follows pharmacy billing procedures, maintains accurate reimbursement references, supports compliance requirements, and may contact patients about outstanding balances and billing options.

Reviews, processes, and troubleshoots prior authorization requests for medications through phone, fax, and web submissions. Researches claims, communicates authorization criteria and request status to providers, provides formulary information, follows Medicare, Medicaid, HIPAA, regulatory, and client-specific requirements, and collaborates with clinical teams to meet accuracy, compliance, and performance goals.

Drafts, reviews, and negotiates contracts; manages contract lifecycles, legal templates, records, and filings; researches statutes and case law; prepares legal documents and correspondence; and provides legal guidance on business initiatives, policies, and compliance. The role supports senior legal leadership and requires independent legal analysis, organization, and collaboration.

Partners with IT hiring managers to develop talent acquisition strategies, source and screen candidates, build diverse pipelines, and present qualified talent. Provides recruiting consultation, interview guidance, offer support, vendor coordination, TA systems maintenance, reporting, and special-project leadership. Helps maintain recruiting policies, procedures, communications, and organizational talent acquisition programs while mentoring colleagues and promoting Navitus’ employment brand.

Designs, deploys, and manages enterprise cloud security solutions across AWS and Azure. Responsibilities include automating security controls, managing AWS WAF and CDK rules, improving policies, patching vulnerabilities, implementing DevSecOps practices, assessing cloud applications and APIs, monitoring security posture, analyzing logs, triaging issues, and supporting compliance and risk initiatives.

Provides application development, configuration, troubleshooting, documentation, testing, and administration across enterprise and SaaS platforms. Works with analysts and business users to gather requirements, automate workflows, support change control, and maintain custom processes. Develops solutions using Microsoft, Atlassian, Oracle, Dynamics, and data movement platforms, while supporting compliance, after-hours assistance, and backup administration.

The Senior Account Manager manages key client relationships and supports operational projects for specialty drug benefit clients. Responsibilities include developing client solutions, resolving member escalations with call center support, gathering project requirements and timelines, managing client operational needs such as member letters, and participating in product development requirements gathering and QA. The role also supports compliance, culture, and learning programs.

Leads the proposal development function, managing a team responsible for RFPs, RFIs, best-and-final offers, retention bids, and sales documents. Oversees proposal strategy, content libraries, financial savings models, performance guarantees, risk identification, project coordination, and collaboration with subject matter experts. Provides consultative support to Sales while recruiting, mentoring, and developing high-performing teams. Requires proposal development expertise, healthcare or PBM industry experience, leadership, and large project management experience.

Designs scalable, secure solutions across AWS Cloud and on-premises environments. Partners with architects, development teams, and business stakeholders to translate requirements into technical specifications, create target-state architectures and roadmaps, evaluate technologies, guide implementation, promote coding standards, estimate effort, and manage delivery risks. The role requires extensive cloud architecture, DevOps, data architecture, software development, modern programming, and cross-platform integration experience.

Supervises workforce management operations, including intraday scheduling, workload analysis, call routing, staffing forecasts, and service-level performance. Leads schedule production, leave and call-out management, staffing reviews, and workload balancing. Collaborates with schedulers and department managers to improve staffing efficiency, develop scheduling enhancements, identify workforce risks, and ensure operational objectives are met. Supports team development, compliance, and adherence to labor agreements and regulations.

Develops, tests, maintains, and enhances software applications throughout the production lifecycle. Responsibilities include coding, performance testing, debugging, documentation, project planning, code reviews, mentoring, end-user training, and researching development technologies. The role supports cloud-native, API-first, microservice, CI/CD, and DevOps practices while collaborating with IT teams and business stakeholders.

Administers enterprise applications, servers, databases, and SaaS platforms, including Oracle Fusion and Atlassian environments. Responsibilities include system monitoring, upgrades, patching, security and access controls, troubleshooting, disaster recovery, change management, performance optimization, vendor coordination, documentation, and after-hours support. The role also contributes to automation, compliance, application testing, and maintaining Linux and Windows environments.

Provides advanced analytical support for Medicaid fee-for-service pharmacy pricing, including MAC pricing, 340B impacts, predictive modeling, forecasting, and regulatory analysis. Maintains external pricing files, validates data, investigates anomalies, and supports Tier 2 inquiries. Collaborates with internal teams, vendors, clients, and state stakeholders to evaluate financial and contractual impacts, ensure compliance, and inform pricing strategies, reporting, program initiatives, and decision-making.

Maintains Medicaid fee-for-service drug pricing methodologies and financial models. Incorporates NADAC, CMS, and HRSA 340B requirements; reconciles FDB and Medi-Span data; analyzes pricing impacts; supports Statements of Work, regulatory submissions, audits, and reporting. Partners with compliance, finance, legal, government programs, and clients to ensure accurate, transparent, and compliant Medicaid reimbursement models.

Leads pharmacy network financial performance across all business lines, including reconciliation, contracted reimbursement guarantees, effective-rate compliance, MAC pricing, variance management, and corrective action. Oversees Network Reconciliation and MAC Pricing teams, ensuring pricing outcomes align with contract terms and enterprise financial goals. Partners with Network Contracting, Underwriting, Finance, and Analytics leaders on governance, audit readiness, market analysis, RFP pricing, and performance execution.