Analyst, Clinical Operations
About The Position
Navitus Health Solutions is seeking a Clinical Operations Analyst to join their team. This role supports the centralized management of Member Prior Authorizations (MPAs) and clinical operational processes within Navitus. The Clinical Operations Analyst is responsible for standardized intake, tracking, documentation, reporting, and coordination of clinical workflows, with a focus on MPA alignment with established governance, compliance requirements, and operational risk controls. This role partners closely with Customer Success, Clinical, Finance, Compliance, Provider Services, and Operations to support consistent, accurate, and timely MPA execution. The position contributes to Navitus’ transition from decentralized MPA handling to a centralized model, aiming to improve consistency, visibility, and scalability of prior authorization management.
Requirements
- Bachelor's degree in business, analytics, healthcare administration, or a related field, or equivalent work experience, required.
- 2+ years of experience in prior authorization processing or support, healthcare operations (PBM, health plan, payer, or provider), Customer Success, Account Management, Client Operations, or clinical operations, utilization management, or benefits administration, required.
- Demonstrated experience managing structured, high-volume work requiring strong attention to detail, prioritization, accurate documentation, and timely follow-through, required.
- Participate in, adhere to, and support compliance program objectives.
- The ability to consistently interact cooperatively and respectfully with other employees.
Responsibilities
- Manage standardized intake, processing, and documentation of Member Prior Authorizations to ensure consistency, transparency, and clear ownership.
- Maintain accurate and complete MPA records to operational execution and audit readiness.
- Partner with cross functional stakeholders to support MPA review and processing in accordance with defined standards and regulatory requirements.
- Monitor MPA volume, trends, and demand to support workload prioritization and operational awareness.
- Adhere to established MPA governance frameworks, including approval requirements, documentation standards and escalation paths.
- Contribute to reporting and performance metrics related to MPA activity and operational effectiveness.
- Develop, maintain, and support recurring and ad hoc reports for clinical operations and account teams, ensuring accuracy and consistency of data outputs.
- Identify process gaps, inconsistencies, or risks related to MPA handling and escalate appropriately.
- Support transition activities as MPA work shifts from decentralized teams into the centralized MPA model.
- Support operational execution of activities tied to client onboarding, formulary changes, and benefit updates.
- Support continuous improvement efforts to enhance standardization, efficiency, and sustainability of MPA management practices.
- Provide support outside normal business hours in urgent situations, as needed.
- Other duties as assigned.
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%
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
