PNOA Network Manager

PNOA Network Manager

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Summary

The PNOA Network Manager is responsible for the management of the PNOA network growth, contracting and servicing processes. This position works closely with the staff in Operations to ensure the accuracy and integrity of client and provider rates. Also responsible for assigned PNOA provider service and negotiations as requested. Responsible for researching and resolving complex network issues, including rate discrepancies and conflicts between provider relationships and client business needs. Cultivates effective relationships with provider representatives, client representatives and internal stakeholders, including adherence to agreed-upon rules of engagement and roles and responsibilities. Adheres to strict procedural and regulatory compliance quality standards, including thorough and accurate documentation, testing protocols, and claims analysis.

Essential Duties and Responsibilities

• Responsible for assigned PNOA service support and management. Monitors and communicates contract language with attorneys or other key individuals who represent pharmacy providers. Manages contract negotiation status, establishes priorities as directed;
• Accountable for the documentation support for the 340B independent pharmacy network to meet 340B client network needs. Responsible for reviewing and approving new 340B client and pharmacy network rates prior to system coding. Responsible for monitoring the client and pharmacy rates on an ongoing basis after a 340B client go live (Maintenance of Business);
• Manages Network Access Client Relationships Serves as the primary point of contact for clients, ensuring their needs are met and fostering long-term relationships, attends weekly calls, provides requests for analysis, identifies, manages and mitigates issues as they arise.
• Serves as the primary PNOA contact to research and resolve client and provider appeals.
• Performs Data analysis regularly conducts pharmacy claims analysis using Microsoft Excel.
• Responsible for the development and maintenance of PNOA network development processes and written policies and procedures;
• Works closely with PNOA team members to develop, review and approve provider collateral contract and training material;
• Ensures that all required and most recent PNOA documentation needed to develop a provider network are being utilized by all negotiators and master PDF copies of updated documentation is published
• Responsibility for the maintenance of all PNOA pharmacy documentation for system and pharmacy documentation filing;
• Manages processes to achieve service commitments, including sustainable, measurable, accurate and timely execution of project deliverables. Provides day-to-day business processes and quality standards and measurement criteria. Sets high standard and encourages new ideas for improving organizational performance;
• Utilizes planning, prioritizing, and organizational skills to ensure timely deliverables, high levels of quality, and efficient use of resources. Maintains commitment to operational goals in the face of obstacles;
• Collaborates and cultivates positive relationships with internal and external customers through delivery of sustainable, measurable, accurate, reliable, and timely results that meet or exceed customer expectations. Promptly responds to service failures, resolves issues, and escalates concerns as appropriate;
• Promotes continuous improvement by ensuring adherence to quality principles. Seeks out and actively participates in business initiatives that contribute to service excellence;
• Based upon career path level, completes special projects and assignments (such as leading workgroups, overseeing projects, mentoring team members, etc.);

Supervisory Responsibilities

No supervisory responsibilities

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening / verbal / written). One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and / or Experience

BS / BA and 5+ years' experience or equivalent combination of education and experience, and 2 years' of SME in respective areas

Computer Skills

To perform this job successfully, an individual must have strong knowledge of Microsoft Office with a demonstrated ability to utilize Excel for analysis. Experience as a user of multiple business software applications desired.

Certificates, Licenses, Registrations

Pharmacy Technician License or National Certification desired.

Other Skills and Abilities

Reasoning Ability

Mathematical Skills

Language Skills

Competencies

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and / or move up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities