Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is seeking a Director, Network Informatics & Analytics to lead data governance, informatics, analytics, and quality oversight supporting pharmacy network contracting. The role will develop network models, reporting, analytical validation, and actionable insights to evaluate reimbursement strategies, provider performance, network effectiveness, and financial outcomes across pharmacy segments.
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
- 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!
- Remote work for residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, and Wisconsin
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