Network Contracting Manager

The Network Contracting Manager will be responsible for the management of retail, specialty, and mail order pharmacy contracting, issue management, reporting, and network strategy in support of Navitus’ objectives. The primary responsibility is to develop, implement, execute, and provide ongoing management of pharmacy contracts and relationships with pharmacy partners, including national and regional chain providers, pharmacy services administration organizations (PSAOs) and independent pharmacies for all lines of business. The Network Contracting Manager will evaluate the value obtained from each pharmacy contract on behalf of Navitus and payers and will be responsible to ensure compliance with all contractual obligations of such contracts. The Network Contracting Manager assists with addressing reimbursement issues, determining network needs, evaluating prospective providers, managing all pharmacy and vendor contract negotiations as well as other pharmacy related projects and initiatives across all lines of business and geographies (Commercial, Medicare and managed Medicaid). The Network Contracting Manager will work across multiple departments to fulfill the responsibilities of this role with respect to retail, mail, specialty, and other pharmacy services including necessary administrative duties required to maintain compliance with all state and federal regulations.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Negotiate pharmacy network reimbursement ethically in support of Navitus’ mission to meet or exceed clients’ and Navitus’ needs for all lines of business and programs, including Commercial, Medicare Part D, Managed Medicaid, Exchanges, and Narrow Retail, Specialty, and Mail Order Networks
• Negotiate and execute pay for performance program-specific contracts with pharmacies
• Ensure all Pharmacy Networks comply with applicable regulatory entities and contractual obligations that relate to Value-Based, Quality, and Performance Network initiatives
• Work with clinical teams to identify possible quality measures applicable to pharmacy services for each line of business
• Responsible for audits of the pharmacy quality performance network and any other related pharmacy performance guarantees and metrics
• Assist in the interpretation of data models to establish market competitive pricing to secure new/retained business
• Assist in the determination of pharmacy network reimbursement pricing structures to align with organizational goals
• Review, recommend, and update pharmacy participation agreements and network addendums and effectively resolve pharmacy contract issues
• Develop value proposition to payers for preferred, narrow, specialty, and limited distribution pharmacy networks
• Other duties as assigned

What our team expects from you?

• Bachelor’s degree or higher in a related field is preferred
• Minimum 1 - 3 years PBM or Managed Care experience is highly desired. Prior experience with managing vendors or accounts preferred
• Understanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desired
• Experience with CMS, Medicare, and state Medicaid regulations and guidance is preferred
• Knowledge of health care processes and pharmaceutical claims adjudication systems
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees, Adjudication Systems, Administrative Skills, Biotech and Pharmaceutical, Centers for Medicare and Medicaid Services (CMS), Claims Processing, Compensation and Benefits, Contract Analysis, Contract Management, Contract Negotiation, Contract Requirements, Customer Support/Service, Data Modeling, Diversity, Federal Laws and Regulations, Healthcare, Maintain Compliance, Managed Care, Medicaid, Medicare, Medications, Needs Assessment, Negotiation Skills, Network Administration/Management, Network Performance/Analysis, Network Support, Performance Metrics, Pharmacy, Pricing, Problem Solving Skills, Quality Metrics, Regulations, Reimbursement, Retail, Retail Management, Risk, State Laws and Regulations, Supply Chain, Team Player, Vendor/Supplier Management, Work From Home

USD $101,335.35 - USD $126,669.19 /Yr.

STAR Bonus % (At Risk Maximum)

5.00 - Salaried Non-Management except pharmacists

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm

Remote Work Notification

ATTENTION: Navitus is 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., * Top of the industry benefits for Health, Dental, and Vision insurance

• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance

Navitus, Navitus - 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._____. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.