Returning Candidate? Log back in! Sr. Network Contracting Manager Location US-WI-Madison ID 2024-3873 Category Administration Position Type Full-Time Remote No 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 $105,270.00 - USD $131,588.00 /Yr. Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8:00am to 5:00pm CST Overview

Due to growth, we are adding a Sr. Network Contracting Manager to our Pharmacy Network Contracting department.  

 

The Sr. Network Contracting Manager will be responsible for the management of all major provider chains, retail and mail order pharmacy contracting, issue management, reporting and strategic direction in support of Navitus objectives. The primary responsibility is to develop implement, execute, and provide ongoing management of all 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 Sr. 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 Sr. 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).

 

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

Negotiate pharmacy network strategies 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 NetworksOngoing management of pharmacy network contracts, including timely renewals and updating of financial and legal terms in such contractsNegotiate and execute pay for performance program-specific contracts with pharmaciesEnsure compliance with all Pharmacy Networks comply with applicable regulatory entities and contractual obligations that relate to Value-Based, Quality, and Performance Network initiativesResponsible 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/or limited distribution pharmacy networksOther duties as assigned Qualifications

What our team expects from you?

Bachelor’s degree or higher in a related field or equivalent work experience requiredMinimum 3 years PBM or Managed Care experience is requiredPrior experience with managing vendors or accounts requiredUnderstanding of managed care, retail and specialty pharmacy network concepts and PBM plan designs is requiredExperience with CMS, Medicare, and state Medicaid regulations and guidance is requiredKnowledge of health care processes or 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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