Pharmacy Network Manager

ProCare Rx • Gainesville, GA

2d

About The Position

The Pharmacy Network Manager provides day-to-day operational support for pharmacy questions by phone and email, responds to Network Development requests, and manages pharmacy contracts from initial draft through execution. The role provides contractual education, recruits pharmacies to meet network adequacy needs, supports re-contracting and negotiations with independent pharmacies and small chains, and leads hospice contracting initiatives.

The position maintains contract and demographic information across systems, submits pricing changes to Quality Assurance, assists with RFP responses, and maintains the Pharmacy Administrative Manual. It works with Credentialing to ensure standards are met, investigates pharmacy claim and pricing issues, performs pricing-escalation triage, and coordinates with the MAC/Reimbursement team. Additional work includes participating in weekly GER reviews, supporting new plan implementations, coordinating pharmacy communications, overseeing monthly import reports and weekly data cascading, and preparing audit documentation and supporting URAC accreditation. The manager is expected to deliver timely, high-quality work for internal and external customers.

The role requires a team-oriented, adaptable person who can work independently in a fast-paced environment and use multiple computer systems at once. Strong organization, initiative, attention to detail, communication skills, telephone etiquette, computer proficiency, and the ability to review and learn contract differences are required. An associate’s degree and two years of healthcare experience working with contracts and/or provider relations are preferred; PBM experience is a plus. Physical demands include sitting, standing, and occasional light lifting.

Requirements

• Strong team player who can adapt to a team environment and work independently in a fast-paced environment.
• Ability to work in multiple computer systems simultaneously on a daily basis.
• Excellent telephone etiquette and verbal and written communication skills.
• Highly organized, motivated, and proactive, with a willingness to learn new processes.
• Extreme attention to detail.
• Working knowledge of computers and software applications such as Word, Excel, Adobe, and Outlook.
• Ability to review contracts and learn the differences among contracts.

Nice To Haves

• Associate’s degree.
• Two years of experience in a healthcare setting working with contracts and/or provider relations.
• PBM experience.

Responsibilities

• Provide day-to-day operational support for pharmacy questions by phone and email.
• Respond promptly to pharmacy requests and questions regarding Network Development.
• Initiate and track contracts from initial draft through full execution.
• Provide written and/or verbal contractual education to pharmacies as needed.
• Recruit pharmacies to meet Plan network adequacy requirements or requests and maintain relationships with small independent and chain pharmacies.
• Participate in re-contracting efforts as directed.
• Guide independent pharmacy and small-chain contracts through negotiation and maintain relationships with contracted entities.
• Lead hospice contracting initiatives.
• Update systems with contract data and demographic information.
• Submit pricing changes to the Quality Assurance team.
• Assist with RFP responses.
• Maintain the Pharmacy Administrative Manual (PAM).
• Work with the Credentialing Specialist to ensure credentialing standards are met.
• Investigate pharmacy claim issues and pricing complaints, and perform pricing-escalation triage for the network Analyst.
• Communicate with the MAC/Reimbursement team as required.
• Participate in the weekly GER review call and make system changes based on the reviews.
• Attend meetings for new plan implementations.
• Ensure deliverables are timely and meet expected quality levels for internal and external customers.
• Coordinate and follow up on pharmacy network fax and email blasts as required.
• Oversee monthly import reports and weekly cascading of data through various systems.
• Prepare audit documentation as requested by the manager and support URAC accreditation.

Benefits

• Medical, dental, and vision insurance.
• Short-term and long-term disability insurance.
• Life insurance.
• Paid vacation and holiday pay.
• Employee wellness program.
• 401(k) with company match.
• Employee Assistance Program with confidential support and counseling.
• Employee referral program.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree