Jobs at Navitus Health Solutions

Manages pricing, underwriting, and risk analysis for new and renewing business, RFPs, client retention, and pricing requests. Leads supervisors and analysts, develops and maintains pricing and profitability models, evaluates financial risk and guarantees, applies underwriting standards, supports client presentations, reports performance metrics, and drives process, quality, and model improvements.

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.

Manages pharmacy rebate operations, including manufacturer and GPO rebate submissions, claims analysis, contract review, guarantee reconciliation, forecasting, reporting, audit support, and client recommendations. Provides sales and RFP support, coordinates with Finance, Underwriting, Analytics, Client Services, and external stakeholders, and serves as a subject matter expert for rebate audits and regulated reporting.

Analyzes pharmacy benefit contract operations, claims data, manufacturer agreements, financial guarantees, rebates, and contract reconciliation. Supports formulary design, contract optimization, pricing risk, client renewals, RFPs, audits, regulated reporting, and contract-processing system maintenance. Serves as a subject matter expert for client reporting and audit activities while coordinating with Finance, Underwriting, Analytics, Client Services, manufacturers, and clients.

Accountant II will support multiple entities through journal entries, general ledger and intercompany reconciliations, invoicing, accounts receivable, cash application, fixed asset accounting, month-end close, variance analysis, audit and tax requests, unclaimed property compliance, and ACH payment processing. The role requires collaboration across departments and is hybrid in Madison, Wisconsin, with two to three office days weekly.

Manages retail, specialty, and mail-order pharmacy network contracts and relationships. Responsibilities include negotiating reimbursement and performance agreements, ensuring regulatory and contractual compliance, auditing quality metrics, evaluating network needs and providers, resolving contract issues, developing payer value propositions, and collaborating with clinical and operational teams across commercial, Medicare, Medicaid, and exchange programs.

Performs clinical pharmacy operations for specialty medications, including prescription verification, medication reconciliation, drug interaction screening, patient education, side-effect management, and telephonic consultations. Reviews and processes prescriptions, coordinates with providers and pharmacies, oversees pharmacy technicians, documents interventions, supports quality assurance, manages medication errors, and maintains compliance with regulatory and pharmacovigilance standards.

Develops and maintains IT governance policies, procedures, standards, and controls aligned with ITIL, regulatory requirements, and business goals. Evaluates access, change, incident, and service management controls; monitors governance effectiveness; recommends process improvements; coordinates incident response and corrective actions; supports controlled change implementation; and leads major incident management processes while collaborating with technical teams, business stakeholders, and vendors.

Leads the provider relations strategy for Lumicera Direct, overseeing provider engagement, account management, support operations, and inside sales. Builds executive relationships with provider organizations, drives growth, referrals, retention, adoption, and revenue, and leads strategic initiatives across commercial and operational teams. Owns budgeting, workforce planning, CRM vendor relations, performance reporting, and continuous improvement while serving as a pharmacist subject matter expert. Represents the organization with providers and industry stakeholders and travels up to 40% of the time.

Owns strategy and relationships for complex PBM client accounts, including health plans, employers, brokers, consultants, and TPAs. Leads QBRs, resolves complex issues, translates claims and clinical data into recommendations, identifies upsell opportunities, and mentors Account Executives. Collaborates with Sales, Clinical, Analytics, Operations, and Product teams to improve client outcomes, retention, program adoption, and long-term growth.

Administers pharmacy reimbursement processes, including network rate testing, pricing setup, electronic payments, remittances, recoveries, quality assurance, compliance monitoring, reporting, and audit support. Researches pharmacy payment issues, identifies improper payments, maintains procedures, and coordinates with provider relations and IT teams to ensure claims adjudication complies with pharmacy contracts.

Analyzes pharmacy claims and contract terms to verify reimbursement accuracy across retail, specialty, and mail-order networks. Performs rate testing, chain audits, compliance monitoring, root-cause analysis, and impact assessments. Develops controls and reporting, resolves pricing issues, submits system change requests, and communicates findings to providers, clients, auditors, and internal leadership. Requires collaboration across departments and continuous improvement of pharmacy pricing operations.

Leads strategic growth and end-to-end proposal development, including RFP evaluation, pursuit strategy, cross-functional coordination, performance analysis, process improvement, pricing strategy, compliance, and team leadership. Partners with Sales, clinical, operations, finance, and pricing stakeholders to improve win rates, competitive positioning, resource allocation, and client value. Oversees proposal team staffing, development, workflows, quality controls, and continuous improvement initiatives.

Provides telephonic clinical consultations for specialty pharmacy patients, including medication education, reconciliation, drug-interaction screening, side-effect management, and disease-state support. Evaluates prescriptions, clarifies orders with prescribers, verifies controlled substances, documents interventions, resolves patient issues, supports quality and compliance standards, and trains less-experienced pharmacists.

Leads pharmacy network financial performance across all lines of business, overseeing reconciliation, effective rate guarantees, MAC pricing, reimbursement analytics, and pricing governance. The role manages Network Reconciliation and MAC Pricing teams, monitors contractual performance, identifies variances, drives corrective actions, ensures audit readiness, and partners with contracting, underwriting, finance, and analytics leaders to achieve network financial targets.

Supports corporate legal operations by managing licensing processes, preparing legal documents and correspondence, maintaining legal records, conducting legal and regulatory research, monitoring legislative changes, and assisting with interpretation of applicable laws and regulations. The role also performs filing, scheduling, stakeholder communication, and routine administrative duties.

Leads PBM rebate contracting and industry relations with pharmaceutical manufacturers. Develops contract strategies, negotiates rebates and discounts, supports formulary decisions through financial modeling and forecasting, resolves rebate issues, and partners with clinical, operational, and client teams. Manages and develops the rebate contracting team while expanding value-based, indication-based, and medical prescription contracts. Requires pharmacy expertise, PBM experience, contract negotiation skills, Wisconsin licensure eligibility, and up to 20% travel.

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.

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.