Pharmacy Network Manager

ProCare Rx; Gainesville (GA); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health benefits

Vacation

Wellness program

401(k) match

EAP

Referral bonus

Job summary

ProCare Rx is seeking a qualified professional to manage the contract lifecycle and strengthen pharmacy networks. You will support day-to-day pharmacy inquiries by phone and email, drive network development efforts, and track contracts from draft to execution.

The role requires strong attention to detail, excellent communication, and the ability to work across multiple systems. Experience with provider relations or PBM contracts is preferred, with opportunities to contribute to URAC

Qualifications

• Associate's Degree with two years of experience in a health care setting working with contracts and/or provider relations preferred.
• PBM experience is a plus.

Responsibilities

• Support day-to-day operational support for pharmacy questions via phone and/or email.
• Handle Network Development emails; respond to requests and questions from pharmacies.
• Initiate and tracks contract from initial draft to full execution.
• Provide written and/or verbal contractual education for pharmacies as needed.
• Target and recruit additional pharmacies to meet Plan network adequacy requirements.
• Participate in re-contracting efforts as required and directed.
• Shepherd contracts through negotiation for independent pharmacies and small chains.
• Lead Hospice Contracting initiatives.
• Update multiple systems with contract data and demographic information.
• Submit pricing changes to the Quality Assurance team.
• Assist in RFP responses.
• Maintain the Pharmacy Administrative Manual (PAM).
• Work with Credentialing Specialist to ensure credentialing standards are met.
• Investigate pharmacy claim issues; pricing complaints and perform Pricing Escalation triage.
• Communicate with the MAC/Reimbursement team as required.
• Attend GER review call and implement system changes.
• Attend meetings for new plan implementations.
• Ensure deliverables are on time and meet quality levels.
• Coordinate and follow up on pharmacy network communications.
• Oversee monthly import reports and weekly data cascading.
• Prepare documentation for audits (URAC accreditation).

Skills

Team player

Multitasking

Phone etiquette

Detail oriented

Communication

Tech proficiency

Education

Associate's Degree

Tools

Microsoft Word

Excel

Adobe

Outlook

Job description

ESSENTIAL DUTIES AND RESPONSIBLITIES

• Responsible for day-to-day operational support for pharmacy questions via phone and/or email.
• Responsible for Network Development emails; respond to requests and questions from pharmacies in a timely manner.
• Initiate and tracks contract from initial draft to full execution.
• Provide written and/or verbal contractual education for pharmacies as needed.
• Target and recruit additional pharmacies to meet Plan network adequacy requirements and/or requests and maintain network relationships with small independent/chain pharmacies.
• Participate in re-contracting efforts as required and directed.
• Shepherd contracts through the negotiation process for independent pharmacies and small chains and maintain relationships with those contracted entities.
• Lead Hospice Contracting initiatives.
• Update multiple systems with contract data and demographic information, as required.
• Submit pricing changes to the Quality Assurance team.
• Assist in RFP responses.
• Responsible for maintaining the Pharmacy Administrative Manual, (PAM).
• Work with the Credentialing Specialist to ensure credentialing standards are met.
• Investigate pharmacy claim issues; pricing complaints and perform Pricing Escalation triage for the network Analyst.
• Communicate with the MAC/Reimbursement team as required.
• Participate in the weekly GER review call and make changes in the system based on those reviews.
• Attend meetings for new plan implementations.
• Ensure deliverables are on time and meet quality levels as expected by ProCare's internal and external customers.
• Coordinate and follow up on pharmacy network fax/email blasts as required.
• Responsible for oversight of monthly import reports and weekly cascading of data through various systems.
• Prepare documentation for audits, as requested by manager and support URAC accreditation.

QUALIFICATIONS AND REQUIREMENTS

• Must be a strong team player who can adapt to a team environment and work independently in a fast-paced environment.
• Must be able to work in multiple computer systems simultaneously on a daily basis.
• Excellent telephone etiquette and verbal/written communication skills.
• Must be highly organized, motivated, take initiative and possess a willingness to learn new processes.
• Extreme attention to detail required.
• Working knowledge of computers and related software applications such as Word, Excel, Adobe and Outlook a must.
• Must be able to review contracts and learn the differences of each contract.

EDUCATION AND EXPERIENCE

Associate's Degree with two years of experience in a health care setting working with contracts and/or provider relations preferred. PBM experience a plus.

PHYSICIAN DEMANDS

Requires sitting, standing, and occasional light lifting.

The Perks of Joining Our Team:

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
• Time to Recharge: Paid vacation and holiday pay.
• Focus on Your Wellness: We offer a robust Employee Wellness Program.
• Invest in Your Future: 401(k) with a company match.
• Support System: Employee Assistance Program provides confidential support and counseling.
• Get Rewarded for Referring Great People: Employee referral program.

ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at [e-mail].

Equal Opportunity Employer

ProCare Rx is an Equal Opportunity Employer

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.