[Remote] Pharmacy Network Consultant Principal - Remote
Note: The job is a remote job and is open to candidates in USA. Prime Therapeutics is a unique pharmacy benefit manager focused on connecting care for those they serve. The Pharmacy Network Consultant Principal is responsible for the development, performance, and management of pharmacy networks, including contract negotiations and ensuring compliance with regulations. This role requires collaboration with various teams to optimize network performance and manage pharmacy contracts effectively.
Responsibilities
- 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
Skills
- 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
- 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
- Experience negotiating pharmacy solicitation contracts
Benefits
- 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).
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