Navitus Health Solutions is seeking a Director, PBM Network Contracting to join our Pharmacy Network Contracting department! This role is ideal for someone with previous pricing experience for or with a provider that may include Commercial, Medicare Part D, Managed Medicaid, Exchanges, discount card programs, and 340B programs.
Reporting to the Vice President, Network Management, the Director, Network Contracting is responsible for establishing, entering into, evaluating, and monitoring reimbursements to pharmacy (and other) providers for pharmaceutical dispensing and related services. The individual in this position is responsible for ensuring Navitus obtains market-leading discounts from providers on behalf of its clients and prospective clients, as well as compliance of contractual terms by Navitus to the provider, and vice versa. The individual will negotiate with national and regional chain providers; pharmacy services administrative organization entities, and independent providers. The Director, working in a team environment, will assist with establishing strategies to identify discount opportunities and effectively employ tactics to improve discounts for pharmacy services from providers. The individual will consult with the Pharmacy Network Sales Support Team in support of the department’s responsibility to provide price responses in RFPs for prospective client opportunities. This position works cross functionally with other teams in regard to generic drug trends and discount change effects. The Director is also responsible for strategy to configure provider networks to maximize clients’ access, discount, and quality requirements.
Is this you? Find out more below!
ResponsibilitiesHow do I make an impact on my team?
Primary accountability for executing pharmacy network strategies to meet clients and Navitus needs for all lines of business and programs, including Commercial, Medicare Part D, Managed Medicaid, Exchanges, discount card programs, and 340B programs Execute strategies and action plans for establishment and enhancement of pharmacy participation agreements and network addendums that effectively positions Navitus Ethically negotiate contractual terms with providers in support of Navitus’ mission Build and maintain strong and effective working relationships throughout all pharmacy services distribution channels, including retail pharmacy chains, independent pharmacies, mail service and specialty pharmacy providers, and other service vendors Collaborate with Provider Services Leadership, Clinical and Client Services, payers, and pharmacies regarding operations of quality performance networks and quality opportunities, including but not limited to STARs for Medicare Part D networks Develop processes to assess clinical performance and employ systems to effect application of monetary value to performance and comparing performance across network providers Proactively build and maintain strong and effective working relationships with client/payer teams, clinical teams, business development teams, Operational teams, other Navitus personnel, and other business partners/vendors Assist with the determination of reimbursement pricing structures to align with organizational goals Responsible to monitor and ensure that Pharmacy Network department services, pharmacy contracts, and network pharmacy providers meet all government regulations and statutes Responsible for ensuring division meets all applicable accreditation requirements (e.g. URAC), Medicare Part D program regulations, Managed Medicaid program regulations, and any other accreditation or governmental program, including contracting compliance Monitor Navitus industry events, competition activities, and competitions’ pricing strategies. Develop processes to benchmark Navitus performance to competition and/or industry Monitor compliance of network providers to federal and state rules, statutes, and regulations; and to Navitus and client/payer program requirements Other duties as assigned QualificationsWhat our team expects from you?
Bachelor’s degree in business or healthcare field or equivalent work experience required Minimum two years’ PBM or Healthcare plan experience is preferred; with a strong preference for individuals with provider contracting or pharmaceutical manufacturer contracting experience Minimum of two years’ experience in contract negotiations Previous personnel supervisory experience required Understanding of legal terms and government regulations desired Valid driver’s license required Participate in, adhere to, and support compliance program objectives The ability to consistently interact cooperatively and respectfully with other employeesWhat can you expect from Navitus?
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 Referral Bonus Program – up to $750!We are 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.
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