Remote Pharmacy Relations Specialist II-Contracts&Networks

Navitus

Austin (TX)

Remote

USD 60,000 - 90,000

Full time

5 days ago

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Benefits offered by this job

Health, Dental, Vision insurance

Paid time off 20 days

Parental leave 4 weeks

9 paid holidays

401K match up to 5%

Adoption assistance program

Flexible Spending Account

Educational assistance and memberships

Referral bonus up to $750

Job summary

Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team. This role focuses on contracting with pharmacies, monitoring network compliance, and resolving claim issues to maintain a strong contracted pharmacy network.

Ideal candidates have a pharmacy background, strong communication, and problem-solving skills, plus experience with claims analysis and industry software. This position offers remote work options and comprehensive benefits.

Qualifications

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

Responsibilities

Manage pharmacy contracting with independent pharmacies and select chains/PSAOs; assist with network negotiations, including redline reviews.
Review pharmacy 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, review, and distribute pharmacy communications to meet internal and client requests.
Monitor and report pharmacy compliance with regulations and internal policies.
Review independent pharmacy redlines with minimal input from leadership.
Maintain all aspects of pharmacy network functions, including network design builds, QA measures, and overall claims processing.
Other duties as assigned.