Remote Network Contracting Manager - Pharmacy Contracts

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

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.