Remote Pharmacy Relations Specialist II — Contracts & Networks

Navitus; Hartford (CT); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health, Dental, and 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

Referral Bonus Program – up to $750!

Job summary

Navitus Health Solutions seeks a Pharmacy Relations Specialist to join our team, with at least 2 years in a pharmacy or pharmacy-facing role. You will manage contracting, respond to inquiries, and maintain contracted networks across independent pharmacies, chains, and PSAOs while ensuring compliance with agreements and regulations.

You will support audits, analyze claims, draft communications, and track requests, playing a key role in maintaining network operations and performance.

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 setting experience desired.
• Prior experience analyzing medical and/or pharmacy claims or credentials is highly desired.
• Proficient in Microsoft Office and industry related software.

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

Skills

Pharmacy contracting

Contract review

Claims analysis

Microsoft Office

Communication

Compliance

Education

Pharmacy tech cert

College/2-year degree

Tools

Pharmacy software

Job description

Navitus Health Solutions seeks a Pharmacy Relations Specialist to join our team, with at least 2 years in a pharmacy or pharmacy-facing role. You will manage contracting, respond to inquiries, and maintain contracted networks across independent pharmacies, chains, and PSAOs while ensuring compliance with agreements and regulations.

You will support audits, analyze claims, draft communications, and track requests, playing a key role in maintaining network operations and performance.