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Role Description

Navitus Health Solutions is seeking a Pharmacist, Medicaid to join our team! The Pharmacist, Medicaid is responsible for providing Medicaid clinical, operational, and educational support to Navitus teams. This position will serve as a subject matter expert for Medicaid clinical aspects. The Pharmacist, Medicaid will provide operational support for the delivery of Medicaid clinical information to various business units throughout Navitus, interpretation of Medicaid guidance and state regulations, and support of Medicaid clinical operation processes. This position will be an active member of the Government Clinical Services Team within the Health Strategies Division. The ability to have strong regulatory knowledge related to Medicaid and the ability to concisely translate that for stakeholders and clients is a necessity.

Responsibilities

• Responsible for Medicaid clinical program development and maintenance, performance and outcomes monitoring, and consultative support.
• Provide operational support to internal and external customers related to Medicaid clinical product offerings.
• Provide clinical support for Medicaid related audits and requirements including but not limited to readiness reviews and administrative reviews.
• Serve as a key stakeholder and decision-maker on implementation of new Medicaid clinical requirements.
• Ensure compliance of Federal and State specific regulations as applicable to clients, including but not limited to the Social Security Act, the SUPPORT Act, and State Plans +/- Amendments.
• Responsible for educating internal customers related to Medicaid regulations, programs, and audits.
• Work with Government Programs and Formulary teams to assure timely and accurate submission of all formulary files and UM restrictions in accordance with CMS and state requirements.
• Assist the Clinical Account Executive, Implementation, and Government Programs teams with new Medicaid implementations and with the annual re-implementations including support of the transition process to ensure clinical and operational functionality.
• Serve as a clinical liaison to Navitus Government Programs teams and Clinical Account teams as needed.
• Provide support for quality improvement projects per CMS requirements as needed.
• Provide support for URAC clinical initiatives and projects as needed.
• Collaborate with client vendors as requested by client.
• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.
• Other duties as assigned.

Qualifications

• Bachelor’s degree or Pharm. D required.
• Registered pharmacist with current unrestricted licensure in the State of home office or the ability to gain reciprocity within 4 months.
• Two years of PBM and/or Medicare Part D experience preferred.
• Strong analytical capability.
• Strong positive interpersonal skills to support staff development and retention.

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!