Pharmacy Network Manager

ProCare Rx; United States; Sur place; USD 45 000 - 65 000; Plein temps

Avantages offerts par ce poste

Health benefits

Vacation & holidays

Wellness program

401(k) with company match

Employee Assistance Program

Referral program

Résumé du poste

ProCare Rx is seeking a Contract/Network Coordinator to support pharmacy questions by phone and email, manage contract lifecycles, and expand the provider network. You will work across multiple systems, coordinate credentialing, and assist with RFPs and audits.

The role emphasizes strong communication, organization, and the ability to work in a fast-paced healthcare environment with a focus on accuracy and timely deliverables.

Qualifications

• Strong team player capable of adapting to a fast-paced environment.
• Ability to work across multiple computer systems daily.
• Excellent telephone etiquette and written communication skills.
• Organized, proactive and eager to learn new processes.
• Familiarity with Word, Excel, Adobe and Outlook.

Responsabilités

• Provide day-to-day operational support for pharmacy questions via phone/email.
• Handle network development emails and respond to pharmacy inquiries promptly.
• Initiate and track contracts from draft to execution.
• Provide contractual education for pharmacies as needed.
• Target and recruit pharmacies to meet network adequacy; maintain relationships.
• Support re-contracting, negotiate with independent pharmacies and small chains.
• Update systems with contract data and demographics.
• Submit pricing changes to QA; assist in RFP responses.
• Maintain the Pharmacy Administrative Manual (PAM).
• Coordinate credentialing with the Credentialing Specialist.
• Investigate claim issues and pricing escalations; liaise with MAC/Reimbursement.
• Participate in GER reviews and system updates; attend new plan implementation meetings.
• Ensure deliverables meet quality standards and deadlines.
• Coordinate network communications and monthly import reports.

Connaissances

Team player

Multi-system proficiency

Excellent communication

Highly organized

Willingness to learn

Contract understanding

Formation

Associate’s Degree; 2 years healthcare contracts/provider relations experience preferred

Outils

MS Word

MS Excel

Adobe

Outlook

Description du poste

ESSENTIAL DUTIES AND RESPONSIBLITIES

include but are not limited to the following:

• ● 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.
• ● 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.
• ● 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:

We believe in taking care of our team. You'll enjoy a comprehensive benefits package designed to support your well-being and financial future:

• 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].

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.