Analyst, UM

Navitus Health Solutions is seeking a Utilization Management Analyst to join our team!

The Analyst, Utilization Management role is to be the subject matter expert for configuration in the prior authorization (PA) system(s), in addition to reporting on PA related information. The Analyst is responsible for aiding in the creation and revision of PA documents, system configuration set-up, maintenance, support, and troubleshooting PA tools (including test, demo, and production environments) related to business logic and processes, as well as understanding interfaces with other applications. This position involves maintenance of the PA criteria and/or PA notification workflow rules engine including creation of system overrides, creation and execution of notifications to external entities, management of automatic role assignment, accurate and efficient interdepartmental communication, and management of drug lists required for execution of approvals.

Is this you? Find out more below!

How do I make an impact on my team?

Requires deep subject matter expert knowledge of the PA Criteria and revision process and/or PA Notification process
• Understand business processes and how they relate to technical setup in the PA system, making suggestions and changes that will improve business processes
• Configure and test administration changes required in the systems within required turn-around times. Ensure the enhancement meets the business need and can be administered in an efficient fashion
• Implement new client prior authorization benefit designs
• Ensure clinical workflows are built and notification letters meet regulatory requirements
• Participate in and support capacity planning and the development of long-term strategic goals for systems and software in conjunction with end-users, third party vendors, and department managers
• Maintain prior authorization benefit designs with a high degree of accuracy as validated through audits and testing
• Audit prior authorization setup to ensure it aligns with the client's expectations, and/or government regulations
• Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs
• Adhere to governmental regulations (i.e., HIPAA, CMS, etc.) and processes while executing tasks, when applicable
• Other duties as assigned

What our team expects from you?

• One of the following required: College degree in a science or business-related field, CPhT, or at least 2 years' experience in a related field (PBM, Health Insurance, and/or Prior Authorization)
• Experience and expertise in working across multiple departments, technical and business acumen, and a "track record" of tangible success
• Prior experience with Prior Authorization, or within a PBM preferred
• Intermediate to expert knowledge of the Microsoft Office Suite
• Experience documenting and maintaining configuration and process information
• Requires detailed documentation of application changes
• Hands-on troubleshooting experience with a complex multi-user business application
• Knowledge of workflow management systems including role and document management
• Knowledge of prior authorization processes in a health care environment preferred
• Experience implementing processes to meet regulatory compliance requirements
• Knowledge of Medicare D regulatory requirements required prior to or soon after hire
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

• 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!

#LI-Remote