Remote Pharmacy Relations Specialist II

Navitus; Harrisburg (Dauphin County); Remote; USD 65,000 - 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%

Job summary

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team and strengthen our contracted pharmacy network. The PRS II will execute contracts with pharmacies, respond to inquiries, and handle operational tasks to maintain networks.

The ideal candidate has at least 2 years in a pharmacy setting, experience with network agreements, and a proven ability to manage communications with pharmacies while ensuring regulatory compliance.

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 experience desired.
• Prior experience analyzing medical and/or pharmacy claims or credentials is 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 with independent pharmacies and PSAOs, including redline reviews.
• Review pharmacy contract setup for compliance with network agreements.
• Support pharmacy audits and network compliance initiatives.
• Research and solve to resolve claim issues.
• Respond to and track requests and communications with network pharmacies.
• Develop and distribute pharmacy communications for internal and client requests.
• Monitor and report pharmacy compliance with governing regulations and internal policies.
• Review independent pharmacy redlines with minimal input from senior leadership.
• Maintain all aspects of maintenance related to pharmacy network functions (network plan design, QA, claims processing).
• Other duties as assigned.

Skills

Business experience

Microsoft Office

Communication skills

Team collaboration

Pharmacy claims analysis

Regulatory compliance

Customer service

Education

College degree / 2-year technical degree or equivalent experience

Certified Pharmacy Technician

Tools

Pharmacy software

Job description

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team and strengthen our contracted pharmacy network. The PRS II will execute contracts with pharmacies, respond to inquiries, and handle operational tasks to maintain networks.

The ideal candidate has at least 2 years in a pharmacy setting, experience with network agreements, and a proven ability to manage communications with pharmacies while ensuring regulatory compliance.