Network Contracting Manager

Navitus Health Solutions, LLC; United States; Remote; USD 101,000 - 127,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

PTO

Parental leave

Holidays

401K match

Adoption assistance

FSAs

Education support

Job summary

Navitus Health Solutions is seeking a Network Contracting Manager to join our team. This role oversees retail, specialty, and mail order contracts, issue management, reporting, and network strategy to support Navitus and payer objectives.

The manager will develop and manage contracts and relationships with national and regional pharmacy partners, PSAOs and independents, ensuring compliance with contractual obligations and regulatory requirements across all lines of business.

Qualifications

• Bachelors degree in a related field is preferred.
• 1-3 years PBM or Managed Care experience is highly desired; vendor/account management experience is a plus.
• 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 is preferred.
• Knowledge of healthcare processes and pharmaceutical claims adjudication systems.
• Adherence to compliance program objectives and cooperative teamwork is expected.

Responsibilities

• Negotiate pharmacy network reimbursement in support of client and Navitus needs across Commercial, Medicare Part D, Managed Medicaid, Exchanges and various networks.
• Negotiate and execute pay-for-performance contracts with pharmacies.
• Ensure networks comply with regulatory entities and contractual obligations related to value-based initiatives.
• Collaborate with clinical teams to identify quality measures for pharmacy services.
• Audit pharmacy quality performance networks and related guarantees and metrics.
• Assist in data interpretation to establish market-competitive pricing and negotiations.
• Help determine reimbursement pricing structures to align with organizational goals.
• Review and update participation agreements and addendums; resolve contract issues.
• Develop value propositions to payers for preferred, narrow, specialty, and limited distribution networks.
• Perform other duties as assigned.

Education

Bachelors degree or higher in a related field

Job description

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.___________________________________________

Current associates must use SSO login option at https://employees-navitus.icims.com/ 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)

7.50 - Salaried Non-Management except pharmacists

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm

Remote Work Notification

ATTENTION: Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.

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!

#LI-Remote

Location : Address

Remote

Location : Country

US