Sr. Analyst, Clinical Operations
$67,657–$67,657 year
RemoteHawaii, United States or South Carolina, United States
Job Summary
Own and execute complex, high-risk Member Prior Authorizations requiring advanced judgment and cross-functional coordination. Serve as a subject matter expert for MPA standards, governance, and regulatory requirements while partnering with senior stakeholders to resolve escalations and risk-based issues. Analyze MPA activity to identify trends, systemic risks, and process gaps, recommending improvements to standardization and efficiency. Present clinical operational data and insights to clients and internal stakeholders, supporting MPA Analysts with standards application and scenario navigation. Maintain accurate records for audit readiness and contribute to performance metrics and governance framework refinements. This role supports the transition of MPA work from decentralized teams into a centralized model. Navitus offers top industry benefits including 20 days PTO, 4 weeks parental leave, and a 401K match.
Required Qualifications
- Bachelor's degree in business, analytics, healthcare administration, or a related field, or equivalent work experience, required.
- 5+ years of progressively complex experience in prior authorization operations, oversight, or escalation support; healthcare operations (PBM, health plan, payer, or provider); Customer Success, Account Management, or Client Operations supporting complex or strategic clients; or clinical operations, utilization management, or benefits administration involving higher-risk or non-standard scenarios, required.
- Proven ability to manage complex, high volume, and high impact work requiring advanced judgment and decision making in ambiguous situations, prioritization across competing demands and stakeholder needs, accurate and defensible documentation, risk awareness, and ownership of outcomes with timely resolution of escalations, required.
Desired Qualifications
- CPhT license preferred.
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