Senior Pharmacy Contracting Professional

Humana

1d • Remote

About The Position

Become a part of our caring community and help us put health first The Senior Pharmacy Contracting Professional understands pharmacy network business processes and works with the department to meet Medicare, Medicaid, and state compliance requirements and engages with business partners for the Pharmacy Networks and Contracting Team. The role will also be responsible for being a point-of-contact during audits and tracking action items to completion. The Senior Pharmacy Contracting Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Pharmacy Contracting Professional is responsible for reviewing state legislation and federal regulations to ensure contracts, policies and procedures are compliant. Manages the oversight of process implementation and issue resolution by working with business stakeholders and appropriate Compliance representatives. Point-of-contact for Pharmacy Networks and Compliance for audits and is responsible for tracking open items through resolution. Works with ESP and PRIME. Requires cross-departmental collaboration and maintains frequent contact with business partners across the organization. Key Responsibilities Understand the impacts of new federal or state guidance and/or legislation on the pharmacy network and contracts Corrective action/plan development: partner with business stakeholders to implement corrective actions and process improvements Understand the pharmacy networks, their purpose, and impacts on other business processes and areas Demonstrate a comprehensive understanding of the relationship between business needs and appropriate solutions Close process gaps identified by Compliance Use inquisitive, forward-looking, big picture thinking to improve processes and business outcomes Influence others to gain support for initiatives or changes that will close gaps and/or improve business outcomes Establish solid relationships with business groups in order to influence and understand on-going business needs Use your skills to make an impact

Requirements

• Bachelor's Degree
• 3 or more years experience in pharmaceutical industry or compliance related role
• Strong business acumen with proficiency in analyzing and interpreting legislation, regulation, and contracts
• Ability to manage multiple tasks and deadlines with attention to detail
• Ability to communicate effectively and deliver presentations to senior management
• Able to give direction and make sound business decisions
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice To Haves

• Process improvement experience

Responsibilities

• Understand the impacts of new federal or state guidance and/or legislation on the pharmacy network and contracts
• Corrective action/plan development: partner with business stakeholders to implement corrective actions and process improvements
• Understand the pharmacy networks, their purpose, and impacts on other business processes and areas
• Demonstrate a comprehensive understanding of the relationship between business needs and appropriate solutions
• Close process gaps identified by Compliance
• Use inquisitive, forward-looking, big picture thinking to improve processes and business outcomes
• Influence others to gain support for initiatives or changes that will close gaps and/or improve business outcomes
• Establish solid relationships with business groups in order to influence and understand on-going business needs
• Use your skills to make an impact

Benefits

• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
• Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level