Senior Pharmacy Network Contract Manager - Remote

The University at Albany, State University of New York; Anchorage (AK); Remote; USD 89,000 - 177,000; Full time

Job summary

A leading healthcare organization is looking for a remote Pharmacy Network Contracting Specialist who will manage provider contracts and relationships. This role involves strategic provider engagement, negotiation, and ensuring compliance with contract obligations. The position offers competitive salary options, benefits, and opportunities for career growth in a mission-driven environment.

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Qualifications

• 3+ years of experience with pharmacy network contracting.
• Understanding contract language and legal implications.
• Experience in managing provider contracts and relationships.

Responsibilities

• Lead and assist with contractual negotiations.
• Develop provider network strategies and evaluate contracts.
• Communicate effectively with providers to manage expectations.

Skills

Understanding of key pharmacy reimbursement models

Collaboration in a cross-functional environment

Utilizing financial tools and reports

Knowledge of competitor landscape in PBM market

Effective communication with providers

Tools

SalesForce

PowerBI

Responsive (formerly RFPIO)

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Lead and assist with contractual negotiations
• Develop and execute on provider strategy development
• Maintain an ongoing knowledge of provider's business as well as their contract with OptumRx
• Provide positive alternatives to complex situations encountered by providers and manage expectations
• Escalate provider concerns internally and to help solve complex issues
• Communicate effectively with providers via face-to-face meetings, conference calls and written correspondence
• Manage contractual obligations including but not limited to contract compliance
• Be a self-starter, produce quality work, make decisions, and deliver on commitments
• Drives development of the provider network yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance
• Performs contract negotiation and pricing - evaluates and negotiates contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
• Establishes and maintains solid business relationships with Pharmacy providers, and ensures the network composition includes an appropriate distribution of provider specialties
• Balance financial and operational impact of contracts to providers, members, and different customer groups when developing and/or negotiating contract terms
• Support evaluation of market rates and provider performance in order to establish provider rates and negotiation strategies
• Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
• Identify and gather information regarding provider issues in order to develop and/or implement strategy to resolve matter, keep manager informed of progress, or escalate issue to appropriate internal business partner
• Represent department in external meetings (e.g., ancillary providers; physician groups; facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned and explain results/decision/activities
• Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship
• Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
• Other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 3+ years of experience with pharmacy network contracting or PBM experience
• Experience understanding and utilizing applicable financial tools and reports (e.g., internal financial models; external reports) to develop contract rates
• Experience understanding contract language in order to assess financial and operational impact and legal implications of requested contract changes
• Experience understanding the competitor landscape within the PBM market (e.g., rates; market share; products; provider networks; market intelligence; GeoAccess)
• Experience utilizing appropriate contract management systems to author and execute contracts and to access supplemental contractual documents
• Experience collaborating with internal stakeholders and external provider groups in a cross-functional environment
• Understanding of key pharmacy reimbursement models

Preferred Qualifications:

• RFP and/or project management experience
• Experience in SalesForce
• Experience in PowerBI
• Experience in Responsive (formerly RFPIO)
• Process improvement and/or process mapping experience

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.