
1001 - 5000 employees
Founded 2003
💼 Consulting
🛡️ Insurance
🏥 Healthcare
Consulting • Insurance • Healthcare
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.
🔥 1 minute ago
🏈 Alabama, Arizona, +32 more states – Remote
💵 $108.4k - $135.5k / year
⏰ Full Time
🟢 Junior
🟡 Mid-level
💊 Pharmacist
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1001 - 5000 employees
Founded 2003
💼 Consulting
🛡️ Insurance
🏥 Healthcare
Consulting • Insurance • Healthcare
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.
• Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS) • Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services • Review and update algorithms and call scripts at least yearly and with updated clinical guidelines • Develop documentation standards for all clinical outreach • Collaborate with CEC staff to develop and maintain a high quality and consistent MTM product • Assist CEC leadership to develop programs supporting STAR ratings outreach • Provide Medicare Part D clinical, operational, and educational support • Maintain knowledge of MTM program updates and Medicare Part C and D performance measures (STAR ratings) • Serve as a preceptor for APPE students within the CEC department • Adhere to compliance and HIPAA regulations • Perform other duties as assigned
• Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months, may be required based on state of residence laws or client contracts • Other State Pharmacy Licenses may be required as business need dictates • Must continually maintain education credits to maintain active licensure • Minimum of two years clinical experience including direct consultation experience • Experience as a clinical call center lead is preferred • Experience as a member of a multi-disciplinary team is preferred • Professional PBM industry work experience is preferred • Knowledge of applicable data privacy practices and laws is preferred • Knowledge of healthcare industry practices and HIPAA regulations • Spanish-speaking is preferred • Participate in, adhere to, and support compliance program objectives • Ability to consistently interact cooperatively and respectfully with other employees • Must reside in one of the approved states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, or Wisconsin
• 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! • Remote work
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