Specialist, Formulary Operations

🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $20 - $23 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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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

• Perform the daily, weekly, and monthly/periodic administrative functions necessary to update and maintain the formularies for Navitus’ clients for all lines of business • Work with the Formulary Services Supervisors to make all changes to the formulary information accessed by clients • Day to day formulary maintenance • Having advisory input to how this information is presented, maintained, and reviewed • Take formulary information from various sources including the Pharmacy and Therapeutics Committee, the Formulary Advisory Committee, and Clinical Account Executives to coordinate the process of entering the information into the formulary change database and communicating changes to Benefits Systems and Auditing • Maintain up-to-date formulary documents available through multiple resources including ePocrates, web portals, and e-prescribing • Review weekly Medispan Reports for new drugs and drug changes that impact the formulary • Collaborate with clinical and client services throughout new client implementations to capture the formulary information needed for plan set-up • Trouble-shoot various formulary/set-up questions • Approximate travel required (5-10%) • Other duties as assigned

🎯 Requirements

• A minimum of a High School diploma plus knowledge relating to pharmacy practice is required • CPhT/experience as a pharmacy technician strongly preferred • Previous experience with pharmacy claims software is a definite plus • Must have a working knowledge of pharmacy practice including drug names (brand vs. generic, NDC, GPI) and claims processing background (either from managed care or community practice) • Familiarity with Formulary, Prior Authorization, Step Therapy, and other utilization management tools preferred • Strong computer skills (Excel, Word, Outlook) • Strong communication skills (verbal and written) • Needs to work well both independently and in a team setting • Must be able to exercise appropriate judgment as necessary • Requires a high level of initiative and creativity • 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!