Returning Candidate? Log back in! PBM Network Contracting Manager Location US- ID 2024-4053 Category Growth Position Type Full-Time Remote Yes Company Navitus About Us Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other. Pay Range USD $98,383.84 - USD $122,979.80 /Yr. Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 5pm Remote Work Notification ATTENTION: We are unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Overview

Navitus Health Solutions is seeking a Network Contracting Manager to join our Pharmacy Network Contracting department! 

 

The Network Contracting Manager will be responsible for the management of retail, specialty, and mail order pharmacy contracting, issue management, reporting, and network strategy in support of Navitus’ objectives. The primary responsibility is to develop, implement, execute, and provide ongoing management of pharmacy contracts and relationships with pharmacy partners, including national and regional chain providers, pharmacy services administration organizations (PSAOs) and independent pharmacies for all lines of business. The Network Contracting Manager will evaluate the value obtained from each pharmacy contract on behalf of Navitus and payers and will be responsible to ensure compliance with all contractual obligations of such contracts. The Network Contracting Manager assists with addressing reimbursement issues, determining network needs, evaluating prospective providers, managing all pharmacy and vendor contract negotiations as well as other pharmacy related projects and initiatives across all lines of business and geographies (Commercial, Medicare and managed Medicaid). The Network Contracting Manager will work across multiple departments to fulfill the responsibilities of this role with respect to retail, mail, specialty, and other pharmacy services including necessary administrative duties required to maintain compliance with all state and federal regulations.

 

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

Negotiate pharmacy network reimbursement ethically in support of Navitus’ mission to meet or exceed clients’ and Navitus’ needs for all lines of business and programs, including Commercial, Medicare Part D, Managed Medicaid, Exchanges, and Narrow Retail, Specialty, and Mail Order NetworksNegotiate and execute pay for performance program-specific contracts with pharmaciesEnsure all Pharmacy Networks comply with applicable regulatory entities and contractual obligations that relate to Value-Based, Quality, and Performance Network initiativesWork with clinical teams to identify possible quality measures applicable to pharmacy services for each line of businessResponsible for audits of the pharmacy quality performance network and any other related pharmacy performance guarantees and metricsAssist in the interpretation of data models to establish market competitive pricing to secure new/retained businessAssist in the determination of pharmacy network reimbursement pricing structures to align with organizational goalsReview, recommend, and update pharmacy participation agreements and network addendums and effectively resolve pharmacy contract issuesDevelop value proposition to payers for preferred, narrow, specialty, and limited distribution pharmacy networksOther duties as assigned Qualifications

What our team expects from you?

Bachelor’s degree or higher in a related field is preferredMinimum 1 - 3 years PBM or Managed Care experience is highly desired. Prior experience with managing vendors or accounts preferredUnderstanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desiredExperience with CMS, Medicare, and state Medicaid regulations and guidance is preferredKnowledge of health care processes and pharmaceutical claims adjudication systemsParticipate in, adhere to, and support compliance program objectivesThe ability to consistently interact cooperatively and respectfully with other employees

What 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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