Pharmacy Network Consultant Sr.

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

The Pharmacy Network Manager is responsible for development and management of Prime's retail, mail, specialty and quality-based pharmacy networks. This position is responsible for the management of Prime's network vendor's contracting activities ensuring contracting initiatives are effective and completed in accordance to Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies. This position is responsible for representing Network Management on financial audits and network management projects.

Responsibilities

• Negotiate market competitive low to medium-high complexity pharmacy agreements for assigned pharmacies across all channels including retail, mail, specialty and quality-based channels and lines of business aligned to Supply Chain COGS strategies and compliant with Network Management policies

• Create and manage network contracting campaigns with network vendor; analyze information and report contracting performance to Network Management leadership, Network Client Services, Network Financial Analytics, Supply Shared Services, Pharmacy FWA and Audit and other as identified; ensure all contracting initiatives meet competitive discounts and client goals for each campaign

• Work with Prime's reporting and analytics teams to establish network reporting for Prime and vendor's pharmacy networks composition to assess network adequacy, contracting gaps and compliance with regulations

• Represent Network Management department in audits and on cross-functional projects or Network Client Services initiatives

• Perform network development, network analysis and management activities supporting strategy and network management priorities and projects

• Ensure all contractual obligations are in adherence with company policies, regulatory compliance and legal requirements and engage with Legal and Network Management leadership in negotiating non-standard contract language with pharmacies

• Establish, develop, and maintain relationships with chain, PSAOs and independent pharmacy providers

• Manage all legal-to-legal correspondences between Prime and Pharmacy Providers escalating to Prime Legal Counsel as required

• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in finance, business, management, or related field of study, or equivalent combination of education and/or related work experience; HS diploma or GED is required

• 5 years of Network Management experience within Pharmacy Benefit Management (PBM), healthcare or other highly regulated industry; including 3 years of managed care experience in medical or pharmacy network contracting

• Must be eligible to work in the United States without the need for work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Excellent verbal and written presentation skills

• Ability to work independently and on highly complex contract language and agreements; strong attention to detail

• Ability to establish rapport and build relationships at all levels within an organization

• 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 for audiences

• Ability to work with confidential data and maintain privacy

• Ability to evaluate and interpret policies and procedures

Preferred Qualifications

• Master's degree in business, healthcare or related area of study

• Pharmacy contracting experience within a PBM or other related healthcare industry

• Knowledge of and experience within health care/PBM industry, Medicaid, Medicare and health plans

• Familiarity with contract language and pharmacy reimbursement methodologies

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

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

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 (including pregnancy), 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.