Remote Pharmacy Contracting & Network Specialist II

Navitus; Madison (WI); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health benefits

Dental benefits

Vision benefits

Paid time off

Parental leave

Paid holidays

401K match

Adoption assistance

Flexible Spending

Educational assistance

Membership assistance

Referral bonus

Job summary

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team. The PRS II will support pharmacy contracting, respond to inquiries, and maintain contracted pharmacy networks, including redline reviews and compliance with regulations.

Ideal candidates have 2+ years in a pharmacy setting or with pharmacy accounts, proficiency in Microsoft Office, and strong problem-solving skills to resolve claim issues and support audits and communications with network pharmacies.

Qualifications

• 2+ years in a pharmacy or healthcare accounts role.
• Experience analyzing pharmacy claims is preferred.
• Familiarity with network contracts and regulatory guidelines.

Responsibilities

• Manage pharmacy contracting with independents and select chains, including redlines.
• Review contract setup for compliance with network agreements.
• Support audits and network compliance initiatives.
• Resolve claim issues and respond to inquiries from network pharmacies.
• Develop and distribute pharmacy communications for internal and client requests.
• Monitor pharmacy network compliance with government regulations and policies.
• Maintain network functionality including network plan design and claims processing.

Skills

Pharmacy contracting

Network compliance

Claim resolution

Customer inquiries

Regulatory knowledge

Education

Associate degree or equivalent

Tools

Microsoft Office

Pharmacy software

Job description

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team. The PRS II will support pharmacy contracting, respond to inquiries, and maintain contracted pharmacy networks, including redline reviews and compliance with regulations.

Ideal candidates have 2+ years in a pharmacy setting or with pharmacy accounts, proficiency in Microsoft Office, and strong problem-solving skills to resolve claim issues and support audits and communications with network pharmacies.