Negotiate market competitive high-profile and/or complex pharmacy agreements across all channels including retail, mail, and quality based and lines of business aligning with Supply Chain COGS strategies
Lead and implement network initiatives by facilitating and performing network analyses, contracting activities and fee schedule development aligning with strategy, priorities and projects goals
Partner with Prime's reporting and analytics teams to develop network vendor loading rules inclusive of approved preferred pharmacies; maintain key compliance criteria and implement quarterly reporting processes for all contracted network retail pharmacies
Analyze network retail pharmacy quarterly reports to ensure compliance with reporting and participation requirements; collaborate with Clinical Program Directors to identify potential performance gaps; work with internal and external partners to develop and manage corrective action plans
Responsible for effectively managing the pharmacy contract from negotiation of all terms, ensuring Prime and Pharmacy compliance and document retention aligning with Prime's Record Information Management (RIM) policies
Work closely with Prime's legal team to update contract documents including agreements and applications for utilization in contracting/re-contracting activities based on new network participation requirements
Other duties as assigned
Requirements
Bachelor's degree in business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
8 years of Network Management experience within Pharmacy Benefit Management (PBM), healthcare or other highly regulated industry; including 5 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
Additional Qualifications
Excellent verbal and written presentation skills
Demonstrated understanding of network reporting and analysis for specialty pharmacy
Demonstrated ability to establish trust and credibility; form working relationships with all levels of an organization
Demonstrated ability to work independently and on highly complex contract language and agreements; strong attention to detail
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
Master's degree in business, healthcare or related area of study
Demonstrated understanding of retail pharmacy contract language and pharmacy reimbursement methodologies
Pharmacy contracting experience within a PBM or other related healthcare industry
Knowledge of and experience within PBM industry, Medicaid, and Medicare
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
Potential pay for this position ranges from $94,000.00 - $160,000.00 based on experience and skills.
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 rece
Benefits
Health insuranceRemote work options
Additional Information
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.
Job Posting Title
Pharmacy Network Consultant Principal - Remote Job Description
The Network Management Consultant is responsible for development, performance and management of Prime's retail, mail, and quality-based networks aligning with Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies. This includes development of network contracts, participation requirements, analysis of pharmacies, and ensuring contract and regulatory compliance. This position is accountable for creation and management of pharmacy contracts and negotiations to ensure competitiveness and serves as the liaison between Prime's Network Management and Specialty teams.
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