Pharmacy Credentialing & Enrollment Specialist – Payer Networks

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 10%

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Shields Health Solutions

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2011

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Shields Health Solutions is a company that specializes in providing integrated specialty pharmacy solutions. They focus on eliminating disruptions in patient care by offering a comprehensive model that bridges the gap between patients and the specialty medications they need. Shields Health Solutions partners with healthcare providers and drug manufacturers to optimize the impact of specialty pharmacy services. Their approach leverages a clinical model, expert care teams, and a proprietary technology platform to improve patient access to specialty drugs, while reducing the overall cost of care. Shields Health Solutions aims to enhance patient experiences and health outcomes through their innovative solutions in specialty pharmacy integration.

📋 Description

• Assess and fulfill clinical and operational reporting requirements mandated by payor and PBM networks • Prepare and submit applications related to specialty network access for Shields partners • Conduct primary and secondary research supporting contracting, payor access, and specialty formularies • Investigate pharmacy network access at the BIN/PCN/Group level using test claims and other data-driven methods • Support state licensing workstreams, including new applications, credentialing, and re-credentialing • Independently manage multiple contracting and payor-access workstreams • Provide timely customer service to partners regarding contracting and payor access • Identify solutions to non-standard requests and problems • Protect organizational value by maintaining confidentiality • Perform other duties as assigned

🎯 Requirements

• Experience with pharmacy claims, pharmacy benefit plans (BIN/PCN/Group), specialty medications, and specialty pharmacy clinical and operational care models • Ability to communicate results clearly and concisely via Excel tables, email, and PowerPoint slides • Exceptionally organized and data driven • Comfortable and successful handling numerous concurrent work streams • Solid computer skills required, including Microsoft Outlook, Teams, Word, Excel, PowerPoint, internet, and web-based platforms • Data entry and computer skills evaluated through a pre-employment assessment • Preferred: project management and/or healthcare contracting experience • Preferred: clinical, pharmacy, 340B, or pharmacy benefit management knowledge • Organized, high-integrity, strict attention to detail, dependable, quality-focused, empathetic, good listener/communicator, and self-motivated • Energetic, highly motivated team player; extreme discretion and confidentiality essential • Ability to work under deadlines and time pressures • Must be reliable, tolerant, determined, and able to work as part of a close-knit team

🏖️ Benefits

• Equal employment opportunities and non-discrimination protections • Inclusive hiring experience • Application and interview assistance/accommodation available • HIPAA-compliant work environment • Text-message recruiting updates with opt-out option (consent not a condition of employment)