Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is committed to making medications more affordable through innovative pharmacy benefit management. The Sr. Analyst, Government Pricing will provide advanced analytical support for Medicaid pharmacy programs, focusing on pricing methodologies and regulatory impacts to aid in decision-making and program strategy.
Responsibilities
- Supports the development and maintenance of Medicaid Fee-for-Service pharmacy pricing and modeling aligned with the company’s mission, strategies, products, and services
- Oversee core analytical work related to SOW requirements, including, Medicaid MAC pricing analysis, and 340B program impacts and compliance considerations
- Develop, maintain, and enhance cost analysis and predictive trending models to support Medicaid FFS programs, segmented by SOW, pricing methodology, or program initiative
- Lead and manage the capture, ingestion, and maintenance of external pricing files (e.g., NADAC, state MAC files, other benchmarks), including, performing data quality checks and validation, identifying and correcting anomalies or errors, conducting timely market research to support pricing accuracy and responsiveness, and resolve or escalate discrepancies, variance, or other anomalies
- Create and maintain a formal Tier 2 inquiry process for MAC-related issues, including tracking inquiry volume, documenting resolution and outcomes, assessing financial and operational impact, and supporting trend analysis and escalation
- Collaborate with other leaders to interpret and apply Medicaid regulations, state-specific requirements, and program initiatives to analytical models, pricing strategies, and reporting outputs
- Collaborate with internal stakeholders (e.g., Client Services, Contracting, Operations, Compliance) to evaluate the financial and contractual impact of Medicaid pricing and program decisions
- Interact with external stakeholders and vendors, building collaborative relationships to support pricing accuracy, data transparency, and program execution
- Support leadership with ad hoc analysis, forecasting, and scenario modeling related to Medicaid FFS pricing, program changes, and regulatory developments
- Assist leadership in supporting new Medicaid program initiatives, enhancements to pricing methodologies, and expansion of analytical capabilities
- Contribute to the development of client- or state-facing materials and presentations, as needed, to explain pricing methodology, cost drivers, and program impacts
- Periodic and detailed reporting of activities and opportunities to leadership
- Other duties as assigned
Skills
- Bachelor's degree in Finance, Economics, Healthcare Administration, Data Analytics, or related field, or equivalent work experience, required
- 5+ years of experience in PBM, Medicaid pharmacy programs, managed care, healthcare analytics, or pricing analysis required
- Experience supporting Medicaid fee‑for‑service drug pricing methodologies in alignment with federal and state Medicaid requirements required
- Experience preparing documentation, reporting, and analysis to support internal reviews, regulatory inquiries, audits, and client requests required
- Experience working with industry pricing and reference sources, including Medi Span multisource and product codes (e.g., MONY indicators), NADAC pricing files, and HRSA 340B ceiling price data required
- Experience conducting pricing impact analyses and maintaining financial models to support Medicaid Statements of Work (SOWs), amendments, and renewals required
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
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
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company. It was founded in 2003, and is headquartered in Appleton, Wisconsin, USA, with a workforce of 1001-5000 employees. Its website is https://www.navitus.com/.