PNOA Network Manager

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Summary

The PNOA Network Manager is responsible for the management of the PNOA network growth, contracting and servicing processes.  This position works closely with the staff in Operations to ensure the accuracy and integrity of client and provider rates. Also responsible for assigned PNOA provider service and negotiations as requested. Responsible for researching and resolving complex network issues, including rate discrepancies and conflicts between provider relationships and client business needs.  Cultivates effective relationships with provider representatives, client representatives and internal stakeholders, including adherence to agreed-upon rules of engagement and roles & responsibilities.  Adheres to strict procedural and regulatory compliance quality standards, including thorough and accurate documentation, testing protocols, and claims analysis. 

Essential Duties and Responsibilities

• Responsible for assigned PNOA service support and management.  Monitors and communicates contract language with attorneys or other key individuals who represent pharmacy providers.  Manages contract negotiation status, establishes priorities as directed;
• Manages Network Access Client Relationships – Serves as the primary point of contact for clients, ensuring their needs are met and fostering long-term relationships, attends weekly calls, provides requests for analysis, identifies, manages and mitigates issues as they arise.
• Serves as the primary PNOA contact to research and resolve client and provider appeals.
• Performs Data analysis – regularly conducts pharmacy claims analysis using Microsoft Excel.
• Responsible for the development and maintenance of PNOA network development processes and written policies and procedures;
• Works closely with PNOA team members to develop, review and approve provider collateral contract and training material;
• Ensures that all required and most recent PNOA documentation needed to develop a provider  network are being utilized by all negotiators and master PDF copies of updated documentation is published
• Responsibility for the maintenance of all PNOA pharmacy documentation for system and pharmacy documentation filing;
• Manages processes to achieve service commitments, including sustainable, measurable, accurate and timely execution of project deliverables.  Provides day-to-day business processes and quality standards and measurement criteria.  Sets high standard and encourages new ideas for improving organizational performance;
• Utilizes planning, prioritizing, and organizational skills to ensure timely deliverables, high levels of quality, and efficient use of resources.   Maintains commitment to operational goals in the face of obstacles;
• Collaborates and cultivates positive relationships with internal and external customers through delivery of sustainable, measurable, accurate, reliable, and timely results that meet or exceed customer expectations.  Promptly responds to service failures, resolves issues, and escalates concerns as appropriate;
• Promotes continuous improvement by ensuring adherence to quality principles.  Seeks out and actively participates in business initiatives that contribute to service excellence;
• Based upon career path level, completes special projects and assignments (such as such as leading workgroups, overseeing projects, mentoring team members, etc.);

Supervisory Responsibilities

No supervisory responsibilities

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

BS/BA and 5+ years’ experience or equivalent combination of education and experience, and 2 years' of SME in respective areas

Computer Skills

To perform this job successfully, an individual must have strong knowledge of Microsoft Office with a demonstrated ability to utilize Excel for analysis. Experience as a user of multiple business software applications desired.

Certificates, Licenses, Registrations

Pharmacy Technician License or National Certification desired.

Other Skills and Abilities

• Ability to balance a high volume of work & variety of tasks and prioritize urgent issues
• Detail oriented with a high degree of accuracy and follow through
• Strong passion for the customer
• Self-starter with the ability to work independently and as part of a team
• Ability to influence others, lead small workgroups, and coordinate service requests throughout the organization
• Ability to gather, document, and communicate business requirements and client specifications
• Ability to understand and interpret contract language and negotiate favorable contract terms
• Ability to define problems, collects data, establish facts, and draw valid conclusions
• Ability to take informed risks, leads through ambiguity, and successfully manages competing priorities
• Highly knowledgeable of pharmacy benefits operations
• Must have an in-depth understanding of the company’s operations structure, key business applications, and claims adjudication system
• Knowledge of PBM pricing and pharmacy and client financial arrangements
• Ability to negotiate complex pharmacy contract language and rates
• Demonstrated ability to positively interact with pharmacies, clients, customers and assigned staff
• Demonstrated accountability for achieving service commitments in a professional environment

Reasoning Ability

• Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.

Mathematical Skills

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Language Skills.    

• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Competencies To perform the job successfully, an individual should demonstrate the following competencies:

• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location

This position must work on-site at the Tempe, Arizona location for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders.  Remote work is not an option for these purposes.

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required.  Work hours may be changed from time to time to meet the needs of the business.  Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position may require domestic travel.

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.