Remote Pharmacy Network Relations Specialist II

Navitus; Dover (DE); Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro-Mo

Referral Bonus Program – up to $750!

Job summary

Navitus Health Solutions seeks a Pharmacy Relations Specialist to manage contracting with independent pharmacies and select chains, ensuring compliance with network agreements. Responsibilities include responding to inquiries, maintaining communications, and supporting audits and regulatory compliance.

The role requires experience in pharmacy settings, strong analytical skills for claims, and proficiency with Microsoft Office and industry software. Collaborative teamwork is essential.

Qualifications

• College or 2-year technical degree or equivalent experience preferred.
• Certified Pharmacy Technician preferred.
• 3 years business-setting experience.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical/pharmacy claims or credentials is highly desired.
• Proficient in Microsoft Office and industry related software.
• Participate in compliance program objectives.
• Ability to interact cooperatively and respectfully with colleagues.

Responsibilities

• Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs with redline reviews.
• Review contract setup to ensure compliance with network agreements.
• Support pharmacy audits and network compliance initiatives.
• Research and resolve claim issues and concerns.
• Respond to and track inquiries with network pharmacies.
• Develop and distribute pharmacy communications for internal and client requests.
• Monitor and report network compliance with government regulations and internal policies.
• Review independent pharmacy redlines with minimal senior leadership input.
• Maintain network functions, design builds, QA measures and claims processing.

Skills

2+ years experience

Pharmacy claim analysis

Compliance orientation

Customer communications

Team collaboration

Education

College or 2-year Technical Degree or equivalent

Certified Pharmacy Technician

Tools

Microsoft Office

Industry software

Job description

Navitus Health Solutions seeks a Pharmacy Relations Specialist to manage contracting with independent pharmacies and select chains, ensuring compliance with network agreements. Responsibilities include responding to inquiries, maintaining communications, and supporting audits and regulatory compliance.

The role requires experience in pharmacy settings, strong analytical skills for claims, and proficiency with Microsoft Office and industry software. Collaborative teamwork is essential.