Director, Network Informatics, Analytics

🕒 5 days ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $152.1k - $190.1k / year

⏰ Full Time

🔴 Lead

👔 Director

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Own and evolve the informatics framework supporting pharmacy network contracting, including contract attributes, reimbursement methodologies, network hierarchies, and provider identifiers • Establish and maintain data standards, definitions, and governance controls to ensure data consistency, usability, and integrity across systems and reporting environments • Serve as the centralized authority for network and contract data quality, enabling reliable and scalable analytics • Design and develop network models to evaluate reimbursement structures, pricing strategies, and financial impact across pharmacy segments • Build analytical frameworks to assess provider cost, performance, and value (e.g., scorecards, cost-of-care, network efficiency) • Identify optimization opportunities through scenario modeling, trend analysis, and performance insights • Lead development and maintenance of standardized reporting and dashboards for network performance, reimbursement trends, and contract alignment • Deliver actionable insights through routine and ad hoc analyses, including trend identification, outlier detection, and emerging risk monitoring • Establish KPI frameworks to measure network effectiveness, cost efficiency, and overall performance across pharmacy segments • Establish and oversee analytical quality control frameworks to assess alignment between contract intent and observed claims and network performance outcomes • Develop monitoring approaches that surface discrepancies, emerging risks, or unintended financial impacts • Provide analytical insight into the performance of new network builds, contract changes, and reimbursement updates through evaluation of claims outcomes and network performance • Collaborate with Analytics, Finance, IT, Compliance, Legal, and Operations to ensure data transparency, alignment, and visibility into key issues • Support enterprise initiatives including new client implementations, regulatory changes, and network expansion strategies

🎯 Requirements

• Bachelor’s degree in Business, Finance, Analytics, Information Systems, Healthcare Administration, or related field, or equivalent work experience, required. • 7+ years of progressive experience in PBM, healthcare analytics, PBM network operations (not IT networks), pharmacy informatics or equivalent experience required. • 3+ years of leadership experience with a proven ability to develop high-performing teams and deliver tangible results in a professional services environment required. • Demonstrated experience with claims data, network configuration, reimbursement models, and complex data environments required. • Proven ability to lead analytics, reporting, or informatics functions in a regulated healthcare setting required. • Experience supporting contracting, pricing, or network management functions strongly preferred. • Participate in, adhere to, and support compliance program objectives. • The ability to consistently interact cooperatively and respectfully with other employees.

🏖️ Benefits

• 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 • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750!