Senior Consultant, Quality Control & Improvement

November 17

🐻 Alaska – Remote

Although this job is listed in Alaska, this company may be open to hiring remote in other states.

🌺 Hawaii – Remote

Although this job is listed in Hawaii, this company may be open to hiring remote in other states.

+11 more states

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌾 North Dakota – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $98.4k - $123k / year

⏰ Full Time

🟠 Senior

💼 Consultant

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Navitus Health Solutions

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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.

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

📋 Description

• Executes on assigned Quality Process Improvement projects and quality initiatives, including leading work management project, heat mapping project, and roadmaps • Ability to organize information, learn complex technologies and explain concepts and instructions clearly and concisely to all levels of employees • Initiates process improvements, root cause analysis, preventative action implementation, metrics, automation, training, documentation, and compliance • Works with Quality Leader and business partners to clearly define new client implementation testing processes for the enterprise • Attends workgroup meetings to improve upstream processes related to requirements and work management tools • Creates and maintain quality test case templates, workbooks, job aids and provide training for any tools created in this role • Anticipates customer needs and proactively develops solutions to meet them • Attend client implementation calls representing Quality regarding testing and validation to ease client concerns • Identifies patterns, trends, and relationship of data to Forecast and plan resource requirements along with Quality Leader • Create and maintain the Quality Team’s C2D (Capacity to Demand) which assists with forecasting and participate in client implementation FTE planning • Authorizes deviations from standards. When working with Health Plan accounts there are many different challenging scenarios, especially in validation. The standard way that works for an account with 10 plans might not work for an account with 29,000 plan codes. You need to be creative and think outside the box to complete the audit efficiently and accurately • Other duties as assigned

🎯 Requirements

• College degree or work experience equivalent • 10+ years of relevant work experience in the healthcare industry or demonstrated expertise with benefit configuration and testing • Expert level experience using MS Excel filtering, sorting, and analyzing data with ability to write complex Excel formulas • Minimum eight years of experience in leading and implementing process improvement initiatives • Minimum eight years of experience in the health care industry, or equivalent • Knowledge and demonstrated experience with usage of industry standard tools for managing projects and quality improvement initiatives • Experience in creating a heat map and identifying quality gaps for an entire enterprise • Minimum 8 years’ experience in a client facing role with the ability to articulate the PBM process and answer client questions related to quality controls • 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!