Pharmacy Network & Contracts Specialist II

Navitus; Montpelier (VT); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health, Dental & Vision insurance

20 days PTO

4 weeks parental leave

9 paid holidays

401K match up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance Plan and Pro/Mb

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team in a role focused on contracting with pharmacies and maintaining contracted networks. You will engage with independent pharmacies and select chains, support network negotiations, and ensure compliance with contracts and regulatory requirements.

Ideal candidates have 2+ years in pharmacy or accounts interfaces, with a background in claims analysis and strong MS Office skills.

Qualifications

• College or 2-year technical degree or equivalent experience preferred.
• Certified Pharmacy Technician preferred.
• 3 years business-setting experience.
• Retail pharmacy experience or managed care pharmacy setting desired.
• Prior experience analyzing medical and/or pharmacy claims.
• Proficient in Microsoft Office and industry related software.
• Participate in, adhere to, and support compliance program objectives.
• Ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

• Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs and assist management with network negotiations, including redline reviews.
• Review pharmacy contract setup to ensure compliance with network agreements.
• Support pharmacy audits and network compliance initiatives.
• Research and solve claims issues and concerns.
• Respond to and track requests, inquiries, and communications with network pharmacies.
• Develop, review, and distribute pharmacy communications for internal and client requests.
• Monitor and report pharmacy compliance with government regulations and internal policies.
• Review independent pharmacy redlines with limited input from senior leadership.
• Maintain all aspects of pharmacy network functions (network plan design builds, QA measures, and claims processing).
• Other duties as assigned.

Skills

Pharmacy contracting

Network management

Contract negotiations

Claims processing

Compliance

Microsoft Office

Education

College or 2-year Technical Degree

Certified Pharmacy Technician

Tools

Microsoft Office

Pharmacy software

Job description

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team in a role focused on contracting with pharmacies and maintaining contracted networks. You will engage with independent pharmacies and select chains, support network negotiations, and ensure compliance with contracts and regulatory requirements.

Ideal candidates have 2+ years in pharmacy or accounts interfaces, with a background in claims analysis and strong MS Office skills.