Director, Network Informatics, Analytics

🕒 vor 10 Tagen

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $152.077 - $190.096 / Jahr

⏰ Vollzeit

🔴 Experte

👔 Direktor

Jetzt Bewerben

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Navitus Health Solutions

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 2003

⚕️ Krankenversicherung

💊 Pharmazie

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions ist ein Anbieter von Apothekenmanagement-Dienstleistungen (Pharmacy Benefit Manager, PBM), der transparente, menschenzentrierte Lösungen für Gesundheitspläne, Arbeitgeber, Regierungsprogramme und andere Plan-Anbieter bereitstellt. Das Unternehmen betreibt ein 100%iges Durchleitungsmodell mit Kostenaufschlag, das darauf abzielt, Medikamentenkosten zu senken, Formulare zu verwalten, Spezialmedikamente zu managen (einschließlich einer Kosten-plus-Spezialapotheke), die Abwicklung von Leistungsansprüchen, Apothekennetzwerk-Management sowie die Unterstützung und Aktivierung von Mitgliedern zu gewährleisten. Navitus positioniert sich als treuhänderischer Partner mit Fokus auf Bezahlbarkeit, Compliance, klinische Qualität und die Verbesserung von Gesundheitsergebnissen durch maßgeschneiderte PBM-Dienstleistungen und digitale Gesundheitsintegrationen.

Beschreibung

• 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

🎯 Anforderungen

• 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.

🏖️ Vorteile

• 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!