Novus Group

  • Pittsburgh, PA, USA
Novus Group Remote * (Pittsburgh, PA, USA)
Oct 12, 2021
The Pharmacy Coordinator provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and ensuring adherence to the health plan's state and federal multiple drug benefit design offerings. This position responds to physician and pharmacy network provider inquiries concerning oral, injectable and infusion medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Will interact with pharmacy network providers to evaluate, educate and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures.Essential Responsibilities:Communicate effectively with physician and pharmacy network providers to ensure that the needs of the provider and plan member are addressed in a courteous, helpful...
Novus Group Remote * (Pittsburgh, PA, USA)
Oct 03, 2021
The Project Manager is responsible for definition, planning and delivery of complex programs that require cross-functional collaboration and management of interdependencies between a group of projects and/or related activities within the constraint of scope, quality, time and budget. Includes the management of a group of internal, exempt and/or matrixed employees and contractors that serve on the program(s) to deliver solutions for the business.Essential Responsibilities:• Works with business and technical organizations to drive out program strategy and approach. Organizes, plans, and maintains Program roadmap consisting of cross-functional activities/projects.• Work with business and technical organizations to assemble project teams. Lead Project Managers and Program team in the development and maintenance of comprehensive plans for a defined program.• Work with Executive Sponsor and Business Owner of a Program, and other management as required, to achieve the Program objectives....
Novus Group Remote * (Pittsburgh, PA, USA)
Oct 03, 2021
The Senior IT Project Manager defines, plans, and delivers of complex programs that require cross-functional collaboration and management of inter-dependencies between a group of projects and/or related activities within the constraint of scope, quality, time and budget. Includes the management of a group of internal, exempt and/or matrixed employees and contractors that serve on the program(s) to deliver solutions for the business.Requirements:Bachelor's Degree7+ years of relevant experienceMust have AGILE experienceHealth Insurance, HealthEdge and Configuration Management Project experience preferred.
Novus Group Remote * (Pittsburgh, PA, USA)
Sep 30, 2021
Collaborates with business owners/stakeholder to understand business needs, processes project specifications, business case development, cost sheet analysis and data sources. Translates business needs into clearly defined and documented detailed, high quality requirements, functional designs, and system supplemental specifications for new applications or analyzes change requests/enhancements in existing applications. Analyzes data to determine business problem, trends, or opportunities for process improvements. Responsible for testing and provides root cause analysis and corrective action plan. Responsible for verification that the delivered application requirements meet the customer needs based on the specifications, ensuring minimal defects in both UAT and production. Accountable for identification, documentation, and escalation of risks, defects and issues throughout the project lifecycle. Responsible for assisting in the resolution of risks, defects and issues. For smaller...