Manager, Provider Networks

About Us :

Judi Health is a health technology company offering a wide range of benefits administration solutions for employers and health plans. This includes Capital Rx, a public benefit corporation that provides full-service pharmacy benefit management (PBM) solutions to self-insured employers; Judi Health, which offers comprehensive health benefit management solutions for employers, TPAs, and health plans; and Judi, the industry's leading proprietary Enterprise Health Platform. To learn more, visit www.judi.health.

Location : Hybrid (Local to NYC or Denver Metropolitan areas)

Position Responsibilities :

• Oversee day-to-day operations of the Provider Relations Network team responsible for ongoing setup and maintenance of standard and custom pharmacy networks that support all Capital Rx clients.
• Provide guidance, follow up and resolution to internal teams regarding network related inquires and concerns by serving as subject matter expert for the Provider Relations Network team.
• Provide guidance and support to members of the Provider Relations team regarding the pharmacy claims adjudication platform, based on knowledge and expertise of NCPDP standards and processes when needed.
• Develop, manage, and monitor pharmacy networks including those for retail, mail and specialty as well as custom and in-house pharmacy networks to ensure networks are processing appropriately within the pharmacy network claims adjudication system.
• Perform extensive and routine network testing based on network setup, reconfigurations, as well as development changes and upgrades to ensure pharmacy claims are adjudicating and pricing accurately within the pharmacy claims adjudication platform.
• Collaborate with internal teams when implementing and reconfiguring networks based on requirement gathering sessions and documented ADHOC network change requests to ensure network configurations satisfy the intent and expectation of the clients.
• Serve as a liaison to the applicable Development and Product teams to assist with implementation and development of needed enhancements and system bug fixes within the pharmacy network claims adjudication system.
• Provide cross functional support to the Provider Relations and all other internal Capital Rx teams when Network support is needed and applicable.
• Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

Preferred Qualifications :

Qualifications / Profile :

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

Salary Range $75,000—$90,000 USD

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.