[Hiring] Specialist II, Pharmacy Relations @Navitus Health Solutions

Role Description

Due to growth, we are adding a Pharmacy Relations Specialist (PRS II) to our team! The Pharmacy Relations Specialist (PRS II) is a highly motivated professional with at least 2 years of successful experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare. Responsibilities include executing contracts with pharmacies, responding to pharmacy inquiries, and completing the tactical and operational tasks required to maintain contracted pharmacy networks.

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 assigned

Qualifications

• College or 2-year Technical Degree or equivalent experience is preferred. Advanced technical education a plus
• 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
• The ability to consistently interact cooperatively and respectfully with other employees

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!