Remote Pharmacy Relations Specialist II

Navitus; Des Moines (IA); Remote; USD 60,000 - 90,000; Full time

Benefits offered by this job

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

Professional Membership assistance

Referral Bonus up to $750

Job summary

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team remotely. The role focuses on executing contracts with pharmacies, responding to inquiries, and maintaining contracted networks.

The PRS II will support network negotiations, compliance, and communications with pharmacies to ensure smooth operations. The ideal candidate has at least 2 years in a pharmacy setting, with strong Microsoft Office skills and a track record in contract management and claims analysis.

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 pharmacy setting experience 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 consistently 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
• Reviews and responds to independent pharmacy redlines; with little to no input from senior leadership
• Responsible for all aspects of maintenance related to pharmacy network functions, such as, network plan design builds, quality assurance measures and claims processing in general
• Other duties as assigned

Skills

Business experience

Pharmacy claims analysis

Microsoft Office

Compliance awareness

Interpersonal skills

Pharmacy network negotiation

Redline reviews

Education

College/2-year technical degree

Certified Pharmacy Technician

Job description

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team remotely. The role focuses on executing contracts with pharmacies, responding to inquiries, and maintaining contracted networks.

The PRS II will support network negotiations, compliance, and communications with pharmacies to ensure smooth operations. The ideal candidate has at least 2 years in a pharmacy setting, with strong Microsoft Office skills and a track record in contract management and claims analysis.