Jobs at Navitus Health Solutions

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.

Manages physician, prescriber, clinic, and health system accounts by developing long-term strategies, retaining clients, identifying expansion opportunities, resolving escalated issues, monitoring contractual performance, and improving operational costs and clinical outcomes. The role delivers data-driven presentations, provides training, supports colleagues, coordinates with specialty account executives, leads projects, and travels to clinic sites to maintain relationships with clinic leaders and physicians.

Leads enterprise formulary, utilization management, and clinical business development strategy for a pharmacy benefit manager. Oversees formulary decisions, drug pipeline monitoring, prior authorization criteria, P&T governance, regulatory alignment, budgeting, client pursuits, and cross-functional teams. Provides clinical leadership, supervises multiple teams, and ensures strategies improve patient outcomes, manage costs, and support organizational growth.

Analyzes pharmacy contracts, pricing, forecasting, financial models, and network performance for retail, specialty, and mail-order pharmacies. Supports contract negotiations, renewals, strategic partner meetings, reporting, variance analysis, annual planning, and multi-year financial modeling. Collaborates with Finance, Legal, Pharmacy Informatics, Contract Managers, and leadership to develop recommendations and improve contracting performance.

Manage pharmacy contracting, contract redlines, network compliance, audits, pharmacy inquiries, claims issue resolution, communications, plan design builds, quality assurance, and claims processing. The role supports pharmacy network maintenance and government-regulatory compliance within a pharmacy benefit management environment.

Leads specialty pharmacy client support, network strategy, contracting activities, escalations, reporting, vendor coordination, and project implementation. Provides clinical and PBM expertise for specialty drugs, REMS, reimbursement, access, compliance, and lowest-net-cost strategies. Advises clients, manages specialty pharmacy initiatives and contracts, develops scalable processes, and leads a team through hiring, performance management, workload prioritization, and development.

Develops, tests, documents, enhances, and maintains software applications supporting business requirements. Collaborates with internal teams to define specifications, writes and debugs code, monitors performance, prepares status reports, trains end users, and supports application improvements. The role uses C#, .NET, React, AWS, databases, shell scripting, source control, and development tools. On-call availability and some travel may be required.

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.

Analyzes retail, specialty, and mail-order pharmacy contracts and contract alternatives to support network strategy and negotiations. Responsibilities include pricing and reimbursement analysis, forecasting, financial modeling, industry trend monitoring, contract impact analysis, reporting, and issue management. The role collaborates with pharmacy partners, vendors, clients, analytics teams, and internal leadership to improve contracting performance and manage pharmacy network value across commercial, Medicare, and Medicaid lines of business.

Serves as the pharmacy network subject matter expert for RFP, RFI, and proposal responses. Maintains standardized response content, coordinates cross-functional inputs, and ensures accurate client-ready materials. Researches and resolves pharmacy network service requests involving setup, configuration, claims, pricing, access, and escalations. Tracks inquiries and KPIs, identifies recurring issues, and supports process improvements across network operations, contracting, analytics, and implementation teams.

Develops business intelligence applications and data models using Qlik, SQL, and related tools. Performs ETL, data validation, analytics process improvement, and impact analysis for reporting changes. Provides data-driven insights, supports audits and legislative inquiries, leads stakeholder meetings, and mentors teammates as a business intelligence subject matter expert.

Leads platform engineering and FinOps teams responsible for CI/CD, developer tooling, container orchestration, observability, cloud cost governance, and software procurement. Oversees AWS usage optimization, automation, Infrastructure as Code, GitOps, compliance, and platform modernization across a hybrid cloud environment. Partners with infrastructure and cloud operations teams, defines the platform roadmap, and mentors platform engineers, DevOps engineers, and FinOps analysts.