Specialist II, Pharmacy Relations

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $48.7k - $58k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

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

• Manage pharmacy contracting processes with independent pharmacies and select chains/PSAOs • Assist management with network negotiations, including redline reviews • Review pharmacy contract setup for compliance with pharmacy network agreements • Support pharmacy audits and network compliance initiatives • Research and resolve claim issues and concerns • Respond to and track requests, inquiries, and communications with network pharmacies • Develop, review, and distribute pharmacy communications for internal and client requests • Monitor, track, and report pharmacy compliance with government regulations and internal policies and procedures • Review and respond to independent pharmacy redlines with little to no input from senior leadership • Maintain pharmacy network functions, including network plan design builds, quality assurance measures, and claims processing • Perform other duties as assigned

🎯 Requirements

• At least 2 years of successful experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare • College or 2-year Technical Degree or equivalent experience is preferred • Advanced technical education a plus • Certified Pharmacy Technician preferred • 3 years business-setting experience • Retail pharmacy experience or experience in a managed care pharmacy setting desired • Prior experience analyzing medical and/or pharmacy claims or credentials highly desired • Proficient in Microsoft Office and industry related software • Participate in, adhere to, and support compliance program objectives • Ability to consistently interact cooperatively and respectfully with other employees • Residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming are not eligible for remote work

🏖️ 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% with no vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan • Professional Membership assistance • Referral Bonus Program – up to $750%