Pharmacy Network Manager

Pharmacy Network Manager

Description

ESSENTIAL DUTIES AND RESPONSIBLITIES include but are not limited to the following:

• Responsible for day-to-day operational support for pharmacy questions via phone and/or email.

• Responsible for Network Development emails; respond to requests and questions from pharmacies in a timely manner.

• Initiate and tracks contract from initial draft to full execution.

• Provide written and/or verbal contractual education for pharmacies as needed.

• Target and recruit additional pharmacies to meet Plan network adequacy requirements and/or requests and maintain network relationships with small independent/chain pharmacies.

• Participate in re-contracting efforts as required and directed.

• Shepherd contracts through the negotiation process for independent pharmacies and small chains and maintain relationships with those contracted entities.

• Lead Hospice Contracting initiatives.

• Update multiple systems with contract data and demographic information, as required.

• Submit pricing changes to the Quality Assurance team.

• Assist in RFP responses.

• Responsible for maintaining the Pharmacy Administrative Manual, (PAM).

• Work with the Credentialing Specialist to ensure credentialing standards are met.

• Investigate pharmacy claim issues; pricing complaints and perform Pricing Escalation triage for the network Analyst.

• Communicate with the MAC/Reimbursement team as required.

• Participate in the weekly GER review call and make changes in the system based on those reviews.

• Attend meetings for new plan implementations.

• Ensure deliverables are on time and meet quality levels as expected by ProCare’s internal and external customers.

• Coordinate and follow up on pharmacy network fax/email blasts as required.

• Responsible for oversight of monthly import reports and weekly cascading of data through various systems.

• Prepare documentation for audits, as requested by manager and support URAC accreditation.

• QUALIFICATIONS AND REQUIREMENTS

• Must be a strong team player who can adapt to a team environment and work independently in a fast-paced environment.

• Must be able to work in multiple computer systems simultaneously on a daily basis.

• Excellent telephone etiquette and verbal/written communication skills.

• Must be highly organized, motivated, take initiative and possess a willingness to learn new processes.

• Extreme attention to detail required.

• Working knowledge of computers and related software applications such as Word, Excel, Adobe and Outlook a must.

• Must be able to review contracts and learn the differences of each contract.

• EDUCATION AND EXPERIENCE

• Associate’s Degree with two years of experience in a health care setting working with contracts and/or provider relations preferred. PBM experience a plus.

• PHYSICAL DEMANDS

• Requires sitting, standing, and occasional light lifting.

The Perks of Joining Our Team:

We believe in taking care of our team. You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.

• Time to Recharge: Paid vacation and holiday pay.

• Focus on Your Wellness: We offer a robust Employee Wellness Program.

• Invest in Your Future: 401(k) with a company match.

• Support System: Employee Assistance Program provides confidential support and counseling.

• Get Rewarded for Referring Great People: Employee referral program.

• ProCare Rx is an Equal Opportunity Employer

Qualifications

Skills

• Behaviors

• Motivations

Education

Experience

• Licenses & Certifications

• Equal Opportunity Employer

• This employer is required to notify all applicants of their rights pursuant to federal employment laws.

• For further information, please review the Know Your Rights notice from the Department of Labor.