Remote Pharmacy Network Relations Specialist II

Navitus; Oklahoma City (OK); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health, Dental, Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro. M

Referral Bonus Program - up to $750

Job summary

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team and drive contracting with pharmacies, respond to inquiries, and maintain contracted networks. The role requires 2+ years in a pharmacy or related interface with pharmacies or accounts and offers remote work across the U.S.

The PRS II will support network negotiations, ensure compliance, resolve claim issues, and communicate with pharmacies to meet internal and client needs. Navitus provides extensive benefits.

Qualifications

• College or 2-year technical degree or equivalent experience preferred; advanced technical education a plus.
• Certified Pharmacy Technician preferred.
• 3 years business-setting experience.
• Retail pharmacy experience or managed care setting desired.
• Prior experience analyzing medical and/or pharmacy claims or credentials highly desired.
• Proficient in Microsoft Office and industry related software.
• Participate in, adhere to, and support compliance program objectives.
• Ability to interact cooperatively and respectfully with other employees.

Responsibilities

• Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs and assist management with network negotiations; inclusive of redline reviews.
• Review pharmacy contract setup to ensure compliance with pharmacy network agreements.
• Support pharmacy audits and network compliance initiatives.
• Research and problem solve to resolve claim issues and concerns.
• Respond to and track requests, inquiries, and communications with network pharmacies.
• Develop, review, and distribute pharmacy communications to meet internal and client requests.
• Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures.
• Review independent pharmacy redlines with little input from senior leadership.
• Maintain all aspects of pharmacy network functions, such as network plan design builds, quality assurance measures and claims processing.
• Other duties as assigned.

Skills

Pharmacy contracting

Contract negotiations

Pharmacy claims analysis

Customer communications

Microsoft Office

Education

College or technical degree

Certified Pharmacy Technician

Tools

Pharmacy software

Job description

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team and drive contracting with pharmacies, respond to inquiries, and maintain contracted networks. The role requires 2+ years in a pharmacy or related interface with pharmacies or accounts and offers remote work across the U.S.

The PRS II will support network negotiations, ensure compliance, resolve claim issues, and communicate with pharmacies to meet internal and client needs. Navitus provides extensive benefits.