Navitus Health Solutions
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Provider Quality Analyst I
at Navitus Health Solutions
LocationAppleton Campus: Appleton, Wisconsin
Bachelor degree required with focus in Business, Process Improvement preferred.
2-5 years business-setting experience. Pharmacy or health systems experience desired.
Pharmacy Technician Certification or functional understanding of clinical methods preferred.
Understanding of legal terms and government regulations desired.
Familiarity with continuous quality improvement (CQI) processes helpful
The Provider Quality Analyst I (Quality Analyst I) is responsible for the development, coordination and continuous improvement of Provider Services clinical and quality performance programs, processes, workflows and internal documentation effectuated through Navitus networks of pharmacies and providers. The Quality Analyst I will assist Provider Services leadership to develop and implement pay for performance programs in support of client payer goals. The individual in this position must be highly detail oriented to identify and develop remedial strategies of areas of improvement via reporting, analysis, testing and process design. The Analyst will also evaluate current satisfactory practices and develop them towards industry leading products.
This person's duties will include coordinating inter- and intra-departmental resources for certain existing and potential Provider Services products. Additional duties include documenting products for internal and external uses, as well as establishing and reporting of measures of success. Other duties include collecting performance metrics from strategic partners and direct analysis from internal sources to report to various stakeholders.
The Analyst is cross-trained to support Provider Services personnel in administration of the Navitus network oversight with providers; resolution of pharmacy service and contractual questions or issues; communication of Navitus, payer, and governmental policies to providers; and general resolution of processing issues.
The Analyst, under the direction and supervision of the Pharmacy Services leadership, will participate in departmental special projects.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Support of Senior Management in the development of Clinical Quality networks including stratification of pharmacies, pay-for-performance (P4P) or other clinical quality metric driven performance
- Develop business cases and specifications for Provider Services programs related to pharmacy quality performance
- Assist and development of prepayment audit process improvement
- Assemble performance metrics from strategic partners and direct analysis from internal sources to report to various stakeholders
- Manages created project plans and communicates with stakeholders, including Provider Services leadership, on completion status
- Support Medicare Plan Finder and similar price file services, including analysis of pricing file processes and submission practices
- Collating and disseminating key performance indicator metrics
- Evaluate and mitigate risk in both the current and proposed process workflows
- Identify deficiencies and success factors, develop solutions, advocate to leadership, and implement process improvement initiatives to maximize quality and efficiencies of existing products and services.
- Maintains open lines of communication and collaborates with other Navitus departments
- Participates in meetings and committees regarding goals, vision and strategic plans
- Other related duties as assigned/required.