United States onlyCompany
NavitusAbout Us
Navitus - 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.Pay Range
USD $77,546.00 - USD $95,148.00 /Yr.Work Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am-5pm, CSTRemote Work Notification
ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.Overview
Due to growth, we are adding a Project Manager, Provider Services to our Provider Services department!
The Project Manager, Provider Services Operations will report to the Director, Provider Services Operations and is responsible for working with the Director on the end-to-end delivery of all operational aspects of the Provider Services divisions. This position will involve strategic planning, optimizing operational processes, and ensuring the efficient delivery of pharmacy benefit services. Responsibilities include client implementation and support, auditing and testing for both retail and specialty pharmacies, credentialing, provider services payments, and relations. The Project Manager will also assist with managing all operational aspects of administration, analysis, and quality assurance, and network design.
Is this you? Find out more below!
Responsibilities
How do I make an impact on my team?
- Manage all contractual administration activities including but not limited to the timely loading of contracts, network setup in the claims processing system, and quality control of network pricing
- Effectively identify issues to claims processing, investigate core source problem, propose sustainable solutions or immediate resolution, and oversee solutions to implementation
- Assist with addressing all aspects of maintenance related to pharmacy network functions, such as network plan design builds, quality assurance measures and claims processing in general
- Co-lead compliance to URAC, state regulations, and Navitus’ policy and procedures to ensure a quality credentialed pharmacy network
- Assist with managing the process for submittal, receipt, tracking, and process flow of credentials/contracts
- Acquires and maintains a thorough understanding of all implications of adjudication platform changes while coordinating accordingly with all upstream and downstream stakeholders
- Responsible for maintenance of daily network operations and administration duties, ensuring data integrity and overall network claims adjudication performance within the claims processing system
- Co-manage the daily operational activities of the department including but not limited to service desk requests, reporting request, contract and network updates, creation of new network, network communications and outreach
- Engage in implementation and follow through of legal and compliance requirements. This includes having a strong understanding of Medicare Part D and Medicaid regulatory requirements as well as state law
- Other duties as assigned
Qualifications
What our team expects from you?
- College degree with advanced technical education or equivalent work experience is required
- Pharmacy technician certification preferred
- 4 years of successful project management experience required
- 2 years of retail pharmacy/Pharmacy Benefit Manager (PBM) experience preferred
- Experience and desire to work with internal and external partners required
- Demonstrated experience with Microsoft Office and other applications as required
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
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.
