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Sr. Analyst, Clinical Operations

Navitus Health Solutions, LLC • Full-time • Remote (United States) • 1w ago

Company

Navitus

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm

Remote Work Notification

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Hiring Manager : Full Name: First Last

Ronald LaDuke

Overview

Due to growth, we are adding a Sr. Clinical Operations Analyst to our team!

The Sr. Clinical Operations Analyst leads the execution of complex, high risk, or high impact Member Prior Authorizations (MPAs) within the centralized MPA model. This role serves as a subject matter expert for MPA standards, governance, and risk management, partnering closely with senior stakeholders across Customer Success, Clinical, Finance, Compliance, and Operations.

The Sr. Clinical Operations Analyst plays a key role in driving consistency, mitigating compliance and operational risk, and advancing continuous improvement efforts to strengthen and scale centralized prior authorization management.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

Own and execute complex or high-risk Member Prior Authorizations requiring advanced judgment and cross functional coordination.
Serve as a subject matter resource for MPA standards, governance, and regulatory requirements.
Partner with senior stakeholders to resolve complex MPA scenarios, escalations, and risk-based issues.
Participate in client-facing meetings, as needed, to provide subject matter expertise on clinical operational processes, including Member Prior Authorizations, reporting, and implementation-related activities
Present and explain clinical operational data, reporting outputs, and process-related insights related to MPAs to clients and internal stakeholders
Serve as a resource to support MPA Analysts in resolving questions, applying standards, and navigating complex execution scenarios.
Analyze MPA activity to identify trends, systemic risks, and process gaps related to MPA handling and recommend improvement opportunities.
Lead or support initiatives that improve standardization, efficiency, and scalability of MPA management processes.
Contribute to performance metrics, reporting, and insights related to MPA activity and operational effectiveness.
Support refinement of governance frameworks, decision criteria, and escalation pathways to improve consistency and control.
Support standardized intake, processing, and documentation of MPAs to ensure consistency, transparency, and clear ownership.
Maintain accurate and complete MPA records to support audit readiness, compliance, and reporting needs.
Apply and reinforce adherence to MPA governance frameworks, approval requirements, and escalation paths.
Identify and escalate process-level inconsistencies, inconsistencies, or risks identified during MPA execution.
Support transition activities as MPA work shifts from decentralized teams into the centralized MPA model.
Other duties as assigned.

Qualifications

What our team expects from you?

Bachelor's degree in business, analytics, healthcare administration, or a related field, or equivalent work experience, required.
CPhT license preferred.
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.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

What can you expect from Navitus?