Manager, Pharmacy Network Reporting-Remote

Job Description

Job Description

Putting People First in Pharmacy- Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models.

We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them.

At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth.

We welcome new ideas and share a passion for excellent service to our customers and each other.

We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

The Manager, Pharmacy Network Reporting will oversee and manage the Pharmacy Network Reporting Team. The position will support the Navitus Network Contracting, Sales, Account Management, Implementation, and Government Programs departments, as well as the Navitus pharmacy network contract pricing and reporting requirements.

The Manager will oversee and lead Navitus Network Contracting Analysts, Network Reporting, and the Navitus MAC Team to ensure the success of business needs and contract compliance.

The individual will leverage the use of analytics to assist internal customers in making informed decisions, increase Navitus' sales and marketing opportunities, and serve as the Provider Services' primary subject matter expert on Network Contracting and Network Reporting.

This individual will understand and interpret data from the Navitus data warehouse, the Navitus claims adjudication system, pharmacy network databases, NCPDP pharmacy files, Medi-Span files, pharmacy acquisition cost market intel, and other data sources required to facilitate the successful delivery of information.

This position enhances departmental efficiency through Qlikview development and network database improvements. The individual in this position will demonstrate competence in using multiple informatics tools, including MS Office products, Quest Analytics, Qlikview, Blue Relay, and other software tools.

The person in this role will be a data expert with extensive knowledge of Navitus data models, data sources, and data attributes, especially regarding pharmacy networks and pharmacy claims.

The Manager deeply understands pharmacy reimbursement methodologies and generic drug pricing. The individual will support and advise senior leadership regarding provider agreements, administration of the MAC Program, and network adequacy.

The Pharmacy Network Reporting team supports and evaluates agreements with providers through financial price modeling, analysis, and reporting and will play a key role in network contracting strategy.

The Manager is responsible for maintaining and managing a competitive, market-leading MAC Program, including working with pharmacies, clients, vendors, and internal department liaisons to implement and maintain a compliant MAC Program.

This position oversees the monitoring and maintaining Navitus's generic effective rate and other contractual requirements with applicable providers to facilitate adjustments in Navitus' adjudication system to meet contractual terms, which requires a fundamental understanding of the Navitus adjudication system and operational processes.

Is this you? Find out more below!

How do I make an impact on my team?

• Responsible for the career development and training of Pharmacy Network Reporting Team
• Review and analyze Pharmacy Network contracts during negotiation to provide market-leading pricing to Navitus clients
• Collaborate with Underwriting Team to guide RFP response and strategy
• Provider Services primary subject matter expert Network Contracting
• Consult on Retail and Mail contracting strategy and innovation of network contracts
• Collaborate with Provider Services Leadership, Sales, Client Services, payers, and pharmacies regarding network enhancement opportunities to meet client and prospect objectives
• Manage the Navitus MAC Program Team
• Continuously review and pro-actively identify areas of opportunities for pricing and discount performance improvement
• Lead a cross functional team in the creation of a reliable generic forecasting tool to be used in underwriting new business opportunities and client retention efforts
• Intimately and effectively understand applicable data sources and models, including limitations of use and processes to ensure and enhance integrity.

Applicable data sources and models include but are not limited to proprietary internal databases, PC2, Quest Analytics, Qlikview extracts, PAC, Medi-Span, HHSC, and CMS data files

Lead the Navitus Network Reporting Team

What our team expects from you?

BA / BS required with educational concentration consisting of information systems, statistics, finance, actuarial sciences, or business preferred.

Additional courses in a health-related field, especially pharmacy, desirable

• Three years’ PBM or managed care supervisory experience preferred
• Three years’ experience in healthcare economics or PBM analytics desired
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

• Hours / Location : Monday-Friday 8 : 00am-5 : 00pm, CST-Remote
• Paid Volunteer Hours
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program up to $750!
• Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program

LI-Remote