Network Contracting Manager
Budget / Salary$101,335.35–126,669.19
TypeFull-time job
LocationUnited States
Posted3 hours ago
Company
NavitusAbout 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.. Current associates must use SSO login option at to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.Pay Range
USD $101,335.35 - USD $126,669.19 /Yr.STAR Bonus % (At Risk Maximum)
5.00 - Salaried Non-Management except pharmacistsWork Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am to 5pmRemote Work Notification
ATTENTION: Navitus is 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.Overview
Navitus Health Solutions is seeking a Network Contracting Manager to join our team!
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 Networks
Negotiate and execute pay for performance program-specific contracts with pharmacies
Ensure all Pharmacy Networks comply with applicable regulatory entities and contractual obligations that relate to Value-Based, Quality, and Performance Network initiatives
Work with clinical teams to identify possible quality measures applicable to pharmacy services for each line of business
Responsible for audits of the pharmacy quality performance network and any other related pharmacy performance guarantees and metrics
Assist in the interpretation of data models to establish market competitive pricing to secure new/retained business
Assist in the determination of pharmacy network reimbursement pricing structures to align with organizational goals
Review, recommend, and update pharmacy participation agreements and network addendums and effectively resolve pharmacy contract issues
Develop value proposition to payers for preferred, narrow, specialty, and limited distribution pharmacy networks
Other duties as assigned
Qualifications
What our team expects from you?
Bachelor’s degree or higher in a related field is preferred
Minimum 1 - 3 years PBM or Managed Care experience is highly desired. Prior experience with managing vendors or accounts preferred
Understanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desired
Experience with CMS, Medicare, and state Medicaid regulations and guidance is preferred
Knowledge of health care processes and pharmaceutical claims adjudication systems
Participate in, adhere to, and support compliance program objectives
The 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!
Location : Address
RemoteLocation : Country
USOriginally posted on Himalayas
NavitusAbout 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.. Current associates must use SSO login option at to be considered for internal opportunities. We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.Pay Range
USD $101,335.35 - USD $126,669.19 /Yr.STAR Bonus % (At Risk Maximum)
5.00 - Salaried Non-Management except pharmacistsWork Schedule Description (e.g. M-F 8am to 5pm)
M-F 8am to 5pmRemote Work Notification
ATTENTION: Navitus is 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.Overview
Navitus Health Solutions is seeking a Network Contracting Manager to join our team!
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 Networks
Negotiate and execute pay for performance program-specific contracts with pharmacies
Ensure all Pharmacy Networks comply with applicable regulatory entities and contractual obligations that relate to Value-Based, Quality, and Performance Network initiatives
Work with clinical teams to identify possible quality measures applicable to pharmacy services for each line of business
Responsible for audits of the pharmacy quality performance network and any other related pharmacy performance guarantees and metrics
Assist in the interpretation of data models to establish market competitive pricing to secure new/retained business
Assist in the determination of pharmacy network reimbursement pricing structures to align with organizational goals
Review, recommend, and update pharmacy participation agreements and network addendums and effectively resolve pharmacy contract issues
Develop value proposition to payers for preferred, narrow, specialty, and limited distribution pharmacy networks
Other duties as assigned
Qualifications
What our team expects from you?
Bachelor’s degree or higher in a related field is preferred
Minimum 1 - 3 years PBM or Managed Care experience is highly desired. Prior experience with managing vendors or accounts preferred
Understanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desired
Experience with CMS, Medicare, and state Medicaid regulations and guidance is preferred
Knowledge of health care processes and pharmaceutical claims adjudication systems
Participate in, adhere to, and support compliance program objectives
The 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!
Location : Address
RemoteLocation : Country
USOriginally posted on Himalayas
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