Product Manager, Encounter Data

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

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.

📋 Description

• Ensure Navitus submits Encounter Data files compliant with guidance from each State • Collaborate with Encounter Data Business Analysts to ensure compliance and consistency across Encounter Data processes • Lead new Encounter Data implementations • Champion root cause analysis efforts when Encounter Data issues are discovered • Oversee Encounter Data-related fixes and enhancements, including system requirements development and testing • Ensure post-implementation monitoring validates fixes and enhancements • Serve as subject matter expert for Encounter Data questions and system enhancements • Oversee timely and accurate delivery of Performance Guarantee results and use them to improve processes and oversight • Ensure metrics are monitored and reported • Respond to Encounter Data-related questions on RFPs • Identify process improvement opportunities and collaborate with stakeholders to implement improvements • Monitor Encounter Data-related regulatory requirements and ensure compliance • Ensure controls notify appropriate individuals and trigger necessary actions • Perform other duties as assigned

🎯 Requirements

• Associate’s degree in Business, Computer Science, or equivalent work experience required • Bachelor’s degree preferred • 2 years of experience with Medicaid Encounter Data required • Experience successfully leading root cause analysis projects required • Project Management and/or Business Analyst experience preferred • Data analysis experience preferred • Participate in, adhere to, and support compliance program objectives • Ability to consistently interact cooperatively and respectfully with other employees

🏖️ Benefits

• Health insurance • Dental insurance • Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% with no vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan • Professional Membership assistance • Referral Bonus Program – up to $750!