Senior Pharmacy Network Consultant

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $74k - $118k / year

⏰ Full Time

🟠 Senior

🛜 Network Engineer / Network Administrator

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

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.

📋 Description

• Negotiate market-competitive pharmacy agreements across retail, mail, specialty, and quality-based channels and lines of business • Create and manage network contracting campaigns with the network vendor • Analyze contracting information and report performance to Network Management leadership and cross-functional teams • Establish network reporting to assess network adequacy, contracting gaps, and regulatory compliance • Represent Network Management in audits and cross-functional projects • Perform network development, analysis, and management activities supporting strategy and priorities • Ensure contractual obligations comply with company policies, regulations, legal requirements, and Network Management policies • Negotiate non-standard contract language with pharmacies in partnership with Legal and Network Management leadership • Establish, develop, and maintain relationships with chain, PSAO, and independent pharmacy providers • Manage legal-to-legal correspondence between Prime and pharmacy providers, escalating to Prime Legal Counsel as needed • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in finance, business, management, or related field, or equivalent combination of education and/or related work experience • High school diploma or GED required • 5 years of Network Management experience within PBM, healthcare, or another highly regulated industry • 3 years of managed care experience in medical or pharmacy network contracting • Must be eligible to work in the United States without work visa or residency sponsorship • Excellent verbal and written presentation skills • Ability to work independently on highly complex contract language and agreements • Strong attention to detail • Ability to establish rapport and build relationships at all organizational levels • Enhanced organizational skills and ability to manage multiple projects simultaneously • Demonstrated problem-solving ability • Ability to interpret complex data and analyze network information • Ability to synthesize information for varied audiences • Ability to work with confidential data and maintain privacy • Ability to evaluate and interpret policies and procedures • Preferred: Master's degree in business, healthcare, or related area • Preferred: Pharmacy contracting experience within a PBM or related healthcare industry • Preferred: Knowledge of healthcare/PBM industry, Medicaid, Medicare, and health plans • Preferred: Familiarity with contract language and pharmacy reimbursement methodologies • Must comply with job-specific security responsibilities, controls, legal, regulatory, contractual, and internal policy requirements • Must be able to perform essential job functions, with reasonable accommodations available when applicable

🏖️ Benefits

• Benefits, incentives, and additional compensation are available; the posting directs candidates to Prime’s Benefits Page for details • Reasonable accommodations for employees with disabilities • Tobacco-Free Workplace