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 make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

Pay Range

USD $98,383.84 - USD $114,934.37 /Yr.

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F: 8AM-5PM CST

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 Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Overview

Due to growth, we are adding a Sr. Quality Improvement Consultant to our Team!

 

The Sr. Quality Control & 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 all lines of business and all 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 intent and audit approach to gain 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. This position will be responsible for creating a heat map, identifying quality gaps, and recommending and implementing process improvements across the enterprise. The position will be responsible for working with the IT Teams to develop/enhance new automation tools. The position will be responsible for initiating process improvements, root cause analytics, preventative action implementation, metrics, automation, training, documentation, and compliance.

 

Is this you? Find out more below!

Responsibilities

How do I make 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 complex technologies and explain concepts and instructions clearly and concisely to all levels of employees.
• Builds, leads and maintains effective team relationships while monitoring progress and resolving barriers to improve processes and create efficiencies to meet implementation deadlines.
• 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 related 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.
• Serves as a key resource on complex and/or critical issues provide innovative solutions. Attend leadership and client calls serving as a technical resource.
• 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 (Capacity to Demand) which assists with forecasting and participate in client implementation FTE planning.
• Authorizes deviations from standards. When working with Health Plan accounts there are many different challenging scenarios, especially in validation. The standard way that works for an account with 10 plans might not work for an account wit