Pharmacy Network Consultant Sr.

Prime Therapeutics•Home, WV

6d•$74,000 - $118,000

About The Position

The Pharmacy Network Manager is responsible for development and management of Prime's retail, mail, specialty and quality-based pharmacy networks. This position is responsible for the management of Prime's network vendor's contracting activities ensuring contracting initiatives are effective and completed in accordance to Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies. This position is responsible for representing Network Management on financial audits and network management projects.

Requirements

Bachelor's degree in finance, business, management, or related field of study, or equivalent combination of education and/or related work experience; HS diploma or GED is required
5 years of Network Management experience within Pharmacy Benefit Management (PBM), healthcare or other highly regulated industry; including 3 years of managed care experience in medical or pharmacy network contracting
Must be eligible to work in the United States without the need for work visa or residency sponsorship

Nice To Haves

Excellent verbal and written presentation skills
Ability to work independently and on highly complex contract language and agreements; strong attention to detail
Ability to establish rapport and build relationships at all levels within an organization
Enhanced organizational skills with the ability to work on multiple projects simultaneously
Demonstrated ability to problem solve and interpret complex data; ability to analyze network information and synthesize it into meaningful information for a variety for audiences
Ability to work with confidential data and maintain privacy
Ability to evaluate and interpret policies and procedures
Master's degree in business, healthcare or related area of study
Pharmacy contracting experience within a PBM or other related healthcare industry
Knowledge of and experience within health care/PBM industry, Medicaid, Medicare and health plans
Familiarity with contract language and pharmacy reimbursement methodologies

Responsibilities

Negotiate market competitive low to medium-high complexity pharmacy agreements for assigned pharmacies across all channels including retail, mail, specialty and quality-based channels and lines of business aligned to Supply Chain COGS strategies and compliant with Network Management policies
Create and manage network contracting campaigns with network vendor; analyze information and report contracting performance to Network Management leadership, Network Client Services, Network Financial Analytics, Supply Shared Services, Pharmacy FWA and Audit and other as identified; ensure all contracting initiatives meet competitive discounts and client goals for each campaign
Work with Prime's reporting and analytics teams to establish network reporting for Prime and vendor's pharmacy networks composition to assess network adequacy, contracting gaps and compliance with regulations
Represent Network Management department in audits and on cross-functional projects or Network Client Services initiatives
Perform network development, network analysis and management activities supporting strategy and network management priorities and projects
Ensure all contractual obligations are in adherence with company policies, regulatory compliance and legal requirements and engage with Legal and Network Management leadership in negotiating non-standard contract language with pharmacies
Establish, develop, and maintain relationships with chain, PSAOs and independent pharmacy providers
Manage all legal-to-legal correspondences between Prime and Pharmacy Providers escalating to Prime Legal Counsel as required
Other duties as assigned