Remote Pharmacy Relations Specialist II

Navitus; Salem (OR); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

Flexible spending account

Education assistance

Referral bonus

Job summary

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

This PRS II position requires collaboration with independents and chains, with emphasis on network compliance and effective communication across teams. Ideal candidates have a background in pharmacy settings, strong contract and claims analysis skills, and proficiency with Microsoft

Qualifications

• College or 2-year Technical Degree or equivalent experience is preferred.
• Certified Pharmacy Technician preferred.
• 3 years business-setting experience.
• Retail pharmacy experience or experience in a managed care pharmacy setting desired.
• Prior experience analyzing medical and/or pharmacy claims or credentials are 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 governing regulations and internal policies and procedures.
• Reviews and responds to independent pharmacy redlines; with little to no input from senior leadership.
• Responsible for maintenance related to pharmacy network functions, such as network plan design builds, quality assurance measures and claims processing.
• Other duties as assigned

Skills

Pharmacy contracting

Claims analysis

Microsoft Office

Compliance

Communication

Team collaboration

Education

College or 2-year technical degree

Certified Pharmacy Technician

Tools

Microsoft Office

Job description

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

This PRS II position requires collaboration with independents and chains, with emphasis on network compliance and effective communication across teams. Ideal candidates have a background in pharmacy settings, strong contract and claims analysis skills, and proficiency with Microsoft