Sr. Consultant, Quality Control & Improvement

Company Navitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to reputed company medications more affordable for the people who need them. At Navitus, reputed company members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new reputed company and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. reputed company associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. Pay Range USD $98,384.00 - USD $122,980.00 /Yr. STAR Bonus % (At Risk Maximum) 5.00 - Salaried Non-Management except pharmacists Work Schedule Description (e.g. M-F reputed company to 5pm) M-F reputed company to 5pm Remote Work Notification ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode reputed company, South Carolina, South Dakota, reputed company Virginia, and Wyoming. Overview reputed company is seeking a Sr. Quality Improvement Consultant to join reputed company! The Sr. Quality Improvement Consultant is an integral part of the Claims Quality Assurance & Testing (QAT) team which performs multiple functions in quality control and quality improvements with a goal to ensure the accuracy of benefit plan configuration in the NavicareRX system for the entire enterprise. They are responsible for ensuring that internal process adherence is met for reputed company lines of business and reputed company departments. This position will be responsible to partner with business partners and implement a work management tool that feeds information to the Claim Adjudication Operations teams. The QAT team reviews the client’s requirements at implementation to determine client reputed company and audit approach to reputed company the expected outcome. This position will collaborate with the Implementation, Account Management, Compliance, and IT teams. This position will utilize system expertise, client documentation, claim adjudication rules, and QAT team processes and procedures to effectively identify coding errors and identify trends to improve processes. Is this you? Find out more below!

Responsibilities

How do I reputed company an impact on my team?

• 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 reputed company technologies and explain concepts and instructions clearly and concisely to reputed company 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 reputed company 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 (reputed company to Demand) which assists with forecasting and participate in client implementation FTE planning
• Authorizes deviations from standards. reputed company working with Health Plan accounts there are many different challenging scenarios, especially in validation. reputed company 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 reputed company the reputed company to complete the audit reputed company and accurately
• Other duties as assigned

Qualifications

What reputed company expects from you?

• 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 reputed company filtering, sorting, and analyzing data with ability to write reputed company reputed company 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 reputed company the PBM process and answer client questions reputed company to quality controls
• 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 Location : Address Remote Location : Country US Apply tot his job Apply To this Job