Job Information
JOB REQUIREMENTS: Pharmacy Benefits Reinvented- As the industry’s alternative pharmacy benefit manager (PBM), we’re committed to making prescriptions more affordable for you and your members. Here at Navitus, our team members work in an environment that celebrates creativity, fosters diversity and encourages growth. We welcome new ideas and share a passion for excellence. Is this you? Find out more below! How do I make an impact on my team? Develops and maintains deep subject matter expertise related to CMS and State Medicaid requirements for provider materials, formulary / PDL, coverage determinations, grievances and appeals, customer care and pharmacy helpdesk, third party liability, 340B, and reporting. Facilitates and oversees the implementation and maintenance of Medicaid functional processes for all Managed Medicaid clients. Develops the necessary project plans and lead projects that enhance the Medicaid operational infrastructure. Participates in state sponsored meetings as requested and disseminates information throughout Navitus. Monitors CMS and State regulations, guidance, and system changes. Ensures the Medicaid functions meet all regulatory requirements. Provides direct functional support for required reporting and provider/member materials. Responsible for operational oversight of the Navitus Managed Medicaid product line. Provides product support for client implementations and subject matter expert support to Navitus Client and Clinical Services Executives representing the client. Supports oversight for issue resolution. Assists with engaging the Program Manger with all non-compliance related issues and/or when obstacles arise. Supports compliance efforts including State, CMS audits and client delegation audits. Supports the development of maintenance of product documentation, including training materials. Accountable for ensuring that policies and procedures (internal controls) are in place to provide reasonable assurance the company assets are protected. Develop and continually evaluate Government Program Operations functions, while monitoring work product measure/targets including turn-around times and accuracy. What our team expects from you? A minimum of a Bachelor’s Degree or equivalent work experience is required. Additional background in business or healthcare administration is desired. Two to five years of relevant experience in administering health insurance programs strongly desired. Experience and expertise in product management, project management and business analysis with a “track record” of tangible success, including team collaboration/relationship-building/management in health care or related environment is essential. Working knowledge of Medicaid regulations, standards, and processes a plus. Ability to be the champion for the Medicaid… 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/E55FA616E1AF4CE0