Pharmacy Network Management Consultant - Remote

Pharmacy Network Management Consultant - Remote

Our work matters. We help people get the medicine they need to feel better and live well. It fuels our passion and drives every decision we make.

Responsibilities

The Network Management Consultant is responsible for development, performance and management of Prime's retail, mail, specialty, and quality-based networks aligning with Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies. This includes development of network contracts, participation requirements, analysis of pharmacies, and ensuring contract and regulatory compliance. This position is accountable for creation and management of specialty fee schedules to ensure competitiveness and serves as the liaison between Prime's Network Management and Specialty teams.

Responsibilities include :

• Negotiating market competitive high-profile and / or complex pharmacy agreements across all channels including retail, mail, specialty and quality based and lines of business aligning with Supply Chain COGS strategies
• Leading and managing specialty fee schedule development process and ensuring fee schedule revisions align with Supply Chains COGS strategies for specialty drug management
• Leading and implementing network initiatives by facilitating and performing network analyses, contracting activities and fee schedule development aligning with strategy, priorities and projects goals
• Partnering with Prime's reporting and analytics teams to develop network vendor loading rules inclusive of approved preferred and specialty pharmacies; maintaining key compliance criteria and implementing quarterly reporting processes for all contracted network specialty pharmacies
• Analyzing network specialty pharmacy quarterly reports to ensure compliance with reporting and participation requirements; collaborating with Specialty Clinical Program Directors to identify potential performance gaps; working with internal and external partners to develop and manage corrective action plans
• Managing the pharmacy contract from negotiation of all terms, ensuring compliance and document retention aligning with Prime's Record Information Management (RIM) policies
• Working closely with Prime's legal team to update contract documents including agreements and applications for utilization in contracting / re-contracting activities based on new network participation requirements
• Other duties as assigned

Education & Experience

Bachelor's degree in business or related area of study, or equivalent combination of education and / or relevant work experience; HS diploma or GED is required. 8 years of Network Management experience within Pharmacy Benefit Management (PBM), healthcare or other highly regulated industry; including 5 years of managed care experience in medical or pharmacy network contracting. Must be eligible to work in the United States without need for work visa or residency sponsorship.

Additional Qualifications

Excellent verbal and written presentation skills. Demonstrated understanding of network reporting and analysis for specialty pharmacy. Demonstrated ability to establish trust and credibility; form working relationships with all levels of an organization. Demonstrated ability to work independently and on highly complex contract language and agreements; strong attention to detail. Enhanced organizational skills with the ability to work on multiple projects simultaneously. Demonstrated ability to problem solve and interpret complex data; ability to analyze network information and synthesize it into meaningful information for a variety of audiences. Ability to work with confidential data and maintain privacy.

Preferred Qualifications

Master's degree in business, healthcare or related area of study. Demonstrated understanding of retail and specialty network fee schedule management. 2 years of experience in specialty contracting. PBM or Healthcare experience.

Physical Demands

Ability to travel up to 15% of the time. Constantly required to sit, use hands to handle or feel, talk and hear. Frequently required to reach with hands and arms. Occasionally required to stand, walk and stoop, kneel, and crouch. Occasionally required to lift and / or move up to 10 pounds and occasionally lift and / or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures. Potential pay for this position ranges from $94,000.00 - $160,000.00 based on experience and skills.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law. Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays. Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members. If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.