Network Contracting Manager

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🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $101.3k - $126.7k / year

⏰ Full Time

🟢 Junior

👔 Manager

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• 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

🎯 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

🏖️ 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% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750!