[Hiring] Network Contracting Manager @Navitus Health Solutions

Role Description

Navitus Health Solutions is seeking a Network Contracting Manager to join our team! The Network Contracting Manager will be responsible for the management of retail, specialty, and mail order pharmacy contracting, issue management, reporting, and network strategy in support of Navitus’ objectives.

• Develop, implement, execute, and provide ongoing management of pharmacy contracts and relationships with pharmacy partners.
• Evaluate the value obtained from each pharmacy contract on behalf of Navitus and payers.
• Ensure compliance with all contractual obligations of pharmacy contracts.
• Assist with addressing reimbursement issues and determining network needs.
• Manage all pharmacy and vendor contract negotiations.
• Work across multiple departments to fulfill responsibilities related to retail, mail, specialty, and other pharmacy services.
• Maintain compliance with all state and federal regulations.

Qualifications

• Bachelor’s degree or higher in a related field is preferred.
• Minimum 1 - 3 years PBM or Managed Care experience is highly desired.
• Prior experience with managing vendors or accounts preferred.
• Understanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desired.
• Experience with CMS, Medicare, and state Medicaid regulations and guidance is preferred.
• Knowledge of health care processes and pharmaceutical claims adjudication systems.
• Ability to consistently interact cooperatively and respectfully with other employees.

Requirements

• Negotiate pharmacy network reimbursement ethically in support of Navitus’ mission.
• Negotiate and execute pay for performance program-specific contracts with pharmacies.
• Ensure all Pharmacy Networks comply with applicable regulatory entities and contractual obligations.
• Work with clinical teams to identify possible quality measures applicable to pharmacy services.
• Responsible for audits of the pharmacy quality performance network and related guarantees.
• Assist in the interpretation of data models to establish market competitive pricing.
• Review, recommend, and update pharmacy participation agreements and network addendums.
• Develop value proposition to payers for preferred, narrow, specialty, and limited distribution pharmacy networks.
• Other duties as assigned.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance.
• 20 days paid time off.
• 4 weeks paid parental leave.
• 9 paid holidays.
• 401K company match of up to 5% - No vesting requirement.
• Adoption Assistance Program.
• Flexible Spending Account.
• Educational Assistance Plan and Professional Membership assistance.
• Referral Bonus Program – up to $750!