Network Management Consultant

7 hours ago

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Prime Therapeutics

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Healthcare Insurance • Pharmaceuticals • SaaS

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

1001 - 5000 employees

Founded 1998

⚕️ Healthcare Insurance

💊 Pharmaceuticals

☁️ SaaS

📋 Description

• Negotiate market competitive high-profile and/or complex pharmacy agreements across all channels including retail, mail, specialty and quality based and lines of business aligning with Supply Chain COGS strategies • Lead and manage specialty fee schedule development process and ensure fee schedule revisions align with Supply Chains COGS strategies for specialty drug management • Lead and implement network initiatives by facilitating and performing network analyses, contracting activities and fee schedule development aligning with strategy, priorities and projects goals • Partner with Prime's reporting and analytics teams to develop network vendor loading rules inclusive of approved preferred and specialty pharmacies; maintain key compliance criteria and implement quarterly reporting processes for all contracted network specialty pharmacies • Analyze network specialty pharmacy quarterly reports to ensure compliance with reporting and participation requirements; collaborate with Specialty Clinical Program Directors to identify potential performance gaps; work with internal and external partners to develop and manage corrective action plans • Responsible for effectively managing the pharmacy contract from negotiation of all terms, ensuring Prime and Pharmacy compliance and document retention aligning with Prime's Record Information Management (RIM) policies • Work closely with Prime's legal team to update contract documents including agreements and applications for utilization in contracting/re-contracting activities based on new network participation requirements • Other duties as assigned

🎯 Requirements

• Bachelor's degree in business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required • 8 years of Network Management experience within Pharmacy Benefit Management (PBM), healthcare or other highly regulated industry; including 5 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 • Excellent verbal and written presentation skills • Demonstrated understanding of network reporting and analysis for specialty pharmacy • Demonstrated ability to establish trust and credibility; form working relationships with all levels of an organization • Demonstrated ability to work independently and on highly complex contract language and agreements; strong attention to detail • 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.

🏖️ Benefits

• To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.