Company
Navitus Pay Range
USD $147,648.00 - USD $184,559.00 /Yr. STAR Bonus % (At Risk Maximum)
17.50 - Sr Director Work Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am to 5pm CT Remote Work Notification
ATTENTION: Navitus is 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. Overview

Due to growth, we are addinga Sr. Director, Pharmacy Network Informatics to our team!

The Sr. Director, Pharmacy Network Informatics will oversee, lead and provide strategic direction to the Navitus Network Pricing Team, Pharmacy Business Impact Analysts, Retail and Specialty Contract Analysts, Network Reporting Team, Business Impact Analyst, Reconciliation, Pharmacy Contract Performance, and the Navitus MAC Team to ensure the success of business needs, financial guarantee, and risk analysis. The Sr. Director will ensure collaboration, partnerships and support of the Navitus Provider Services, Sales, Account Management, Underwriting, Finance, and Government Programs departments The Sr. Director will leverage use of emerging technologies and analytics to assist internal and external customers to make informed decisions to decrease Navitus financial risk and increase Navitus sales, technical advancements, and marketing opportunities and will serve as the Provider Services primary subject matter expert on all existing and prospective clients and RFP response.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Direct the adequacy and performance of Navitus provider networks via data modeling, analysis, and reporting received from the team.
• Develop and oversee pharmacy businessintelligencesdashboards, reports, and analytics infrastructure.
• Partner with internal stakeholders such as Finance, Underwriting, Operations, Compliance, IT to align pharmacy performance metrics, forecasting, KPIswith organizational goals.
• Lead and effectively manage allrisk basedpharmacy performance projects to ensure proper reimbursement, risk mitigation management and forecasting tomaintaincontract compliance effectively communicating to internal and external stakeholders.Leverage large and complex datasets to model financial, clinical, and operational outcomes; translate findings into implementable strategies that optimize benefit design and network performance.
• Effectively interpret data models toestablishprospect and renewal pricing and forecast solutions to secure new/retainedbusiness.
• Support andadvisesenior leadershipregardingprovider agreements, administration of the MAC Program, and network pricing strategy for prospects and renewals.
• Collaborate and lead informatics keyobjectiveswith Provider Services team leads in areas including retail and specialty contracting, pharmacy operations, and client pharmacy services support.
• Responsible formaintainingand managing a competitive, market leading MAC Program including working with pharmacies, clients, vendors, and internal department liaisons to implement andmaintaina compliant MAC Program.
• Main oversight for monitoring and maintaining Navitus generic effective rate, cost-plus, and other contractual requirements and pharmacy pricing methodologies with applicable providers andfacilitatingadjustments in Navitus adjudication system to meet contractual terms.
• Ownership of applicable data sources and models, including limitations of use and processes to ensure and enhance integrity. Applicable data sources and models include but are not limited to proprietary internal databases, PC2, Quest Analytics,Qlikviewextracts, SQL, PAC, Medi-Span, HHSC, and CMS data files.
• Defend governmental and commercial reports as requested in formal audits with third party auditors.Identifymeaningful report validation techniques andparticipatein full validation of audited reports.
• Ownership of the development and maintenance of Policy and Procedures as required by Navitus for all reports requiring formal P26Ps.
• Oversee andidentifyopportunities for maximizing user self-service of pharmacy networks data.Work with the Manager, Pharmacy Network Reporting toidentifyother areas for improvement.Build solutions using the best-fit technology to push information gathering out to the end user
• Lead and inspire high-performing teams by providing strategic direction, aligning talent and resources with organizational goals to drive operational excellence, foster cross-functional collaboration, and promote a culture of continuous improvement across key business initiatives.
• Other duties as assigned

Qualifications

Whatourteamexpectsfrom you?

• Bachelors degree in information systems, statistics, finance, actuarial sciences, or business or equivalent work experiencerequired.Additionalwork experience and/or courses in a health-related field, especially pharmacy benefit management, preferred.
• 10 + years experience in healthcare economics or PBM analyticsrequired.
• 10+ years experience leading and developing multi-disciplinary teamsrequired. Experience leading teams in PBM or managed care preferred.
• Demonstrated experience building and operationalizing Pharmacy Network Informatics structures, frameworks, and modeling toolsrequired.
• Strongtrack recordof leading processes and standard collaboration with external client facing teams.
• 5+ years experience leading informatics and developing data driven analysis to drive pricing methodologies.
• Demonstrated ability to design long-term strategies to support business risk mitigation processes.
• Participate in, adhere to, and support compliance programobjectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

What can you expect fromNavitus?

• Top of the industry benefits forHealth,Dental,and Vision insurance
• 20 dayspaidtimeoff
• 4 weeks paid parental leave
• 9paid holidays
• 401Kcompany match of up to 5%- No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membershipassistance
• Referral Bonus Program 60; up to $750!

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