Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is a company committed to making medications more affordable and celebrates diversity and creativity in its workforce. They are seeking a Director of Network Informatics & Analytics to lead data governance, analytics, and quality oversight supporting pharmacy network contracting, enabling data-driven decision-making and optimizing network performance.
Responsibilities
- Own and evolve the informatics framework supporting pharmacy network contracting, including contract attributes, reimbursement methodologies, network hierarchies, and provider identifiers
- Establish and maintain data standards, definitions, and governance controls to ensure data consistency, usability, and integrity across systems and reporting environments
- Serve as the centralized authority for network and contract data quality, enabling reliable and scalable analytics
- Design and develop network models to evaluate reimbursement structures, pricing strategies, and financial impact across pharmacy segments
- Build analytical frameworks to assess provider cost, performance, and value (e.g., scorecards, cost-of-care, network efficiency)
- Identify optimization opportunities through scenario modeling, trend analysis, and performance insights
- Partner with Finance, Actuarial, and Strategy teams to support forecasting, pricing decisions, and client-facing analytics
- Lead development and maintenance of standardized reporting and dashboards for network performance, reimbursement trends, and contract alignment
- Deliver actionable insights through routine and ad hoc analyses, including trend identification, outlier detection, and emerging risk monitoring
- Establish KPI frameworks to measure network effectiveness, cost efficiency, and overall performance across pharmacy segments
- Establish and oversee analytical quality control frameworks to assess alignment between contract intent and observed claims and network performance outcomes
- Develop monitoring approaches that surface discrepancies, emerging risks, or unintended financial impacts
- Perform root cause analysis and partner with cross-functional teams to inform resolution strategies (without direct ownership of execution)
- Provide analytical insight into the performance of new network builds, contract changes, and reimbursement updates through evaluation of claims outcomes and network performance
- Partner with Network Contracting and Provider Services Operations to support visibility into implementation outcomes and emerging trends
- Develop analytics and reporting that assess whether network design intent is reflected in observed performance
- Surface risks, anomalies, or unintended financial impacts resulting from network or contract changes
- Serve as a key analytics and informatics partner to Network Contracting leadership across all pharmacy segments
- Collaborate with Analytics, Finance, IT, Compliance, Legal, and Operations to ensure data transparency, alignment, and visibility into key issues
- Support enterprise initiatives including new client implementations, regulatory changes, and network expansion strategies
- Additional duties as assigned
Skills
- Bachelor's degree in Business, Finance, Analytics, Information Systems, Healthcare Administration, or related field, or equivalent work experience, required
- 7+ years of progressive experience in PBM, healthcare analytics, PBM network operations (not IT networks), pharmacy informatics or equivalent experience required
- 3+ years of leadership experience with a proven ability to develop high-performing teams and deliver tangible results in a professional services environment required
- Demonstrated experience with claims data, network configuration, reimbursement models, and complex data environments required
- Proven ability to lead analytics, reporting, or informatics functions in a regulated healthcare setting required
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
- Experience supporting contracting, pricing, or network management functions strongly preferred
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!
Company Overview
Company H1B Sponsorship