Coordinator, UM Operations

NavitusNavitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.USD $20.00 - USD $20.91 /Hr.M-F 7:30 am - 4:00 pmThis position is an onsite role working out of our Appleton office located at 1025 West Navitus Drive, Appleton, WI 54913.Navitus Health Solutions is seeking a UM Operations Coordinator to join our Prior Authorization department!The Coordinator, Utilization Management (UM) Operations role is to support the operational work of the Utilization Management Program. Job duties will include reporting and administrative functions. Specifically, the Coordinator will ensure timely and accurate fulfillment of Prior Authorization Member and Prescriber notifications. The Coordinator will troubleshoot communications that have failed and ensure the communications are processed timely and accurately. This role requires a high attention to detail within short turnaround times. The coordinator will develop and maintain a working knowledge of Prior Authorization systems and workflows. The ability to work collaboratively with others, problem solve and troubleshoot, focus and prioritize work, and understand specific client or regulatory variations is critical.Is this you? Find out more below! How do I make an impact on my team?Assume responsibility for letter fulfillment, monitoring automated fulfillment equipment. Working with Navitus’ vendors to ensure uptime and proper inventoryTroubleshoot failed member and prescriber fulfillment (automated and manual)Develop and maintain expert knowledge of Medicare D, Medicaid, and/or Exchange programsProperly prioritize prior authorization work queues to ensure requests meet internal and client expectationsAdhere to governmental regulations and processes while executing mailing and faxing tasksExecute on project work associated with the various prior authorization products from inception through completionAssist with prior authorization reporting needs as assignedDevelop, document, and maintain policies, procedures and associated training plans as neededOther duties as assignedWhat our team expects from you? High school diploma required. Associate degree or equivalent preferredExperience with a combination of the following: previous administrative work, customer service experience, expertise working across multiple departments, technical and business acumen, and a track record of tangible successExperience in health insurance/pharmacy insurance or managed care organization preferredParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employeesWhat you can expect from Navitus?Top of the industry benefits for Health, Dental, and Vision insurance20 days paid time off4 weeks paid parental leave9 paid holidays401K company match of up to 5% - No vesting requirementAdoption Assistance ProgramFlexible Spending AccountEducational Assistance Program and Professional Membership assistanceReferral Bonus Program - up to $750!#LI-Onsite1025 West Navitus Dr. AppletonWI54913

Created: 2025-10-06