Network Contracting Manager
About The Position
Navitus Health Solutions is seeking a Network Contracting Manager to join their team. This role is responsible for the management of retail, specialty, and mail order pharmacy contracting, issue management, reporting, and network strategy to support Navitus’ objectives. The primary responsibility is to develop, implement, execute, and provide ongoing management of pharmacy contracts and relationships with pharmacy partners, including national and regional chain providers, pharmacy services administration organizations (PSAOs) and independent pharmacies for all lines of business. The Network Contracting Manager will evaluate the value obtained from each pharmacy contract on behalf of Navitus and payers and will be responsible to ensure compliance with all contractual obligations of such contracts. The Network Contracting Manager assists with addressing reimbursement issues, determining network needs, evaluating prospective providers, managing all pharmacy and vendor contract negotiations as well as other pharmacy related projects and initiatives across all lines of business and geographies (Commercial, Medicare and managed Medicaid). The Network Contracting Manager will work across multiple departments to fulfill the responsibilities of this role with respect to retail, mail, specialty, and other pharmacy services including necessary administrative duties required to maintain compliance with all state and federal regulations.
Requirements
- Bachelor’s degree or higher in a related field is preferred
- Minimum 1 - 3 years PBM or Managed Care experience is highly desired.
- Prior experience with managing vendors or accounts preferred
- Understanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desired
- Experience with CMS, Medicare, and state Medicaid regulations and guidance is preferred
- Knowledge of health care processes and pharmaceutical claims adjudication systems
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
Responsibilities
- Negotiate pharmacy network reimbursement ethically in support of Navitus’ mission to meet or exceed clients’ and Navitus’ needs for all lines of business and programs, including Commercial, Medicare Part D, Managed Medicaid, Exchanges, and Narrow Retail, Specialty, and Mail Order Networks
- Negotiate and execute pay for performance program-specific contracts with pharmacies
- Ensure all Pharmacy Networks comply with applicable regulatory entities and contractual obligations that relate to Value-Based, Quality, and Performance Network initiatives
- Work with clinical teams to identify possible quality measures applicable to pharmacy services for each line of business
- Responsible for audits of the pharmacy quality performance network and any other related pharmacy performance guarantees and metrics
- Assist in the interpretation of data models to establish market competitive pricing to secure new/retained business
- Assist in the determination of pharmacy network reimbursement pricing structures to align with organizational goals
- Review, recommend, and update pharmacy participation agreements and network addendums and effectively resolve pharmacy contract issues
- Develop value proposition to payers for preferred, narrow, specialty, and limited distribution pharmacy networks
- 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
