Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Provider Relations Manager - RemoteJob Description

The Manager Provider Relations is responsible for leading and managing a Provider Relations department to ensure effective management of employees, departmental interaction, and process improvements.  This position is accountable for departmental leadership by optimizing the effectiveness and efficiency of customer service to members, providers and clients.  The Manager of Provider Relations works in collaboration with leaders throughout the organization, as well as external stakeholders to ensure resolution to provider and/or client inquires.

Responsibilities

Manage and support the team through the full cycle contract management processes for Commercial, Medicare Part D, Medicaid, and Health Insurance Marketplace and the provider relations team’s workload to ensure quality outcomes, as well as pharmacy and client satisfaction; may be responsible for provider relations, outreach, or independent pharmacy contract functionsOversee and approve new key processes the team develops as part of continuous improvement and develop strategies to achieve world class status in operational effectiveness and pharmacy and client experience while ensuring compliance and adherence to all regulatory guidelinesInteract, collaborate, and support Prime’s commitments to pharmacy clients by creating a strong interface between contact center operations and provider relationsDevelop and maintain relationships with internal and external stakeholders regarding the management and development of Network Management strategiesActively oversee and support Peak Season activitiesMay service as liaison between Prime and pharmacies for applicable legal correspondence, may partner with Prime general counsel as requiredProvide work direction to resolve problems, monitor performance, and provide mentorship, coaching and development for team members to support - department objectivesSupport employee’s participation and success in company recognition programs to improve morale, pharmacy and client service performance and employee retentionOther duties as assigned

Minimum Qualifications

Bachelor’s degree in healthcare, business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required6 years of work experience in customer service or contracting experience within healthcare, PBM or highly regulated industry1 year of leadership/people management experienceMust be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

Ability to learn complex IT systems, both internal and web based and be able to train others to use systems and maintain best practices and quick reference guidesAbove average knowledge of Microsoft Office Suite of products, including Excel and PowerPointDemonstrated business written and oral communication skillsDemonstrated ability to establish and rapport and build relationships at all levels within an organizationStrong attention to detail, follow through and root cause analysis of issuesExcellent organizational, time management, problem solving and analytical skills

Preferred Qualifications

Previous experience in pharmacy network management, legal or compliancePrevious project management skillsPrevious experience with RxClaim

Minimum Physical Job Requirements

Ability to work a flexible schedule including weekends, holidays, and outside of Prime’s core business hoursConstantly required to sit, use hands to handle or feel talk and hearFrequently required to reach with hands and armsOccasionally required to stand, walk and stop, kneel and crouchSpecific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

Reports to Director Pharmacy Relations and Resolution in the Network Integrity Center of Excellence department

Potential pay for this position ranges from $81,000.00 - $138,000.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

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 receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law. 

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.