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UW Medicine Pharmacy has an outstanding opportunity for a FULL-TIME SPECIALTY PHARMACY CONTRACTING MANAGER. The Specialty Pharmacy Contracting Manager is responsible for establishing specialty pharmacy payer contracts on behalf of each partnering health system. The manager will focus on establishing new and managing existing contracts to include specialty pharmacy services for UW Medical Center and Harborview Medical Center. The Pharmacy Contracting Manager will be responsible for managing relationships with payers, third-party administrators, and employer groups. Focused activities will include proposal development, fee schedule analysis, and negotiation of rates and contract terms to maximize reimbursement. The Specialty Pharmacy Contracting Manager is responsible for negotiating with drug manufacturers for access to limited-distribution drugs.
The Specialty Pharmacy Contracting Manager position requires knowledge of pharmacy retail contracting. The Manager will be responsible for building relationships and negotiating with drug manufacturers, third-party administrators, payers, and other contracting groups. Contract analysis and development is a requirement of the position. Access to limited-distribution drugs requires an additional subset of analysis and proposal to drug manufacturers. The position requires knowledge of Specialty Pharmacy regulatory requirements and retail pharmacy operations, financial analysis, and modeling.
DUTIES & RESPONSIBILITIES:
Pharmacy Contracting Program Management:
- Source specialty pharmacy and retail pharmacy payer contracts on behalf of each retail pharmacy network.
- Source limited-distribution drug contracts with drug manufacturers on behalf of each retail pharmacy network.
- Participate in negotiations with our partners while building strong industry relationships.
- Develop specialty pharmacy contracting partnerships with self-funded employers.
- Assist in the development of comparative analysis related to patient total cost of care using reliable skill set in statistical analysis.
- Provide explanation and interpretation of contracts to internal and external customers.
- Responsible for the strategic development and implementation of payer strategies.
- Work closely with legal and business teams to ensure contract language accurately conveys intent.
- Work with the team on state licensing matters, including new applications, credentialing, and re-credentialization.
- Work with team on assessment of reporting requirements.
- Provide clear channels of communication, delegation, and accountability within the team for effective direction and problem-solving.
- Participate in the development, implementation, and evaluation of policies and procedures for the Specialty Pharmacy Program. Assist the Specialty Pharmacy team in the development of new policies and procedures and assure timely review and revision of procedures as the program expands. Assure that all program policies and procedures meet state and federal regulations.
- Communicate third-party payer changes to the pharmacy team and track/forecast the impact of changes.
- Contract redlining, including reviewing contract rates, (Acquisition and AWP pricing) to determine a profitable margin.
- Document control and following the legal contract procedure from initial receipt of the agreement to final execution.
- Communicate new contracts with finance and revenue cycle teams, as well as contract pricing for PBMs and other payer contracts (managed care plans and medical groups).
- Provide contract, grant, and price file surveillance to maintain current coding, rate changes, and ensure contract and regulatory compliance.
The Specialty Pharmacy Contracting Manager will also:
- Perform other duties as assigned.
- Follow UW Medicine security and confidentiality policies and procedures.
- Maintain current professional standards and credentials through study materials and education to stay abreast of continuous changes in the healthcare industry.
- Bachelor Degree in Pharmacy or PharmD
- Current Pharmacist License
- 4-5 years of contracting specialist or equivalent experience.
Master's degree in Business Administration is desired.
Req #: 149525