Prime Therapeutics

Pharmacy Network Consultant Sr.

Prime Therapeutics$74K — $118K *
US-AnywhereRemote in United States
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree in business or a related field; HS diploma or GED required.
  • Minimum of 8 years of Network Management experience in PBM or healthcare; 5 years in managed care network contracting.
  • Excellent verbal and written presentation skills.
  • Strong attention to detail and ability to manage complex contract language.
  • Enhanced organizational skills; able to juggle multiple projects.

Responsibilities

  • Negotiate complex pharmacy agreements across retail, mail, and quality channels.
  • Lead network initiatives through analysis, contracting, and fee schedule development.
  • Partner with reporting teams to develop vendor loading rules for pharmacies and quarterly compliance reports.
  • Analyze quarterly pharmacy reports to identify compliance and performance gaps with collaboration for corrective actions.
  • Manage pharmacy contracts from negotiation to compliance and document retention.
  • Work with legal to update contract documents and ensure compliance with new participation requirements.

Benefits

  • Remote work flexibility.
  • Access to comprehensive health benefits and wellness programs.
  • Generous paid time off and holiday policies.
  • Retirement savings plan with company match.
  • Opportunity for professional growth and development.
Full Job Description
Job Posting Title

Pharmacy Network Consultant Sr.Job Description

The Pharmacy Network Manager is responsible for development and management of Prime's retail, mail, specialty and quality-based pharmacy networks. This position is responsible for the management of Prime's network vendor's contracting activities ensuring contracting initiatives are effective and completed in accordance to Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies. This position is responsible for representing Network Management on financial audits and network management projects.

Responsibilities

  • Negotiate market competitive low to medium-high complexity pharmacy agreements for assigned pharmacies across all channels including retail, mail, specialty and quality-based channels and lines of business aligned to Supply Chain COGS strategies and compliant with Network Management policies

  • Create and manage network contracting campaigns with network vendor; analyze information and report contracting performance to Network Management leadership, Network Client Services, Network Financial Analytics, Supply Shared Services, Pharmacy FWA and Audit and other as identified; ensure all contracting initiatives meet competitive discounts and client goals for each campaign

  • Work with Prime's reporting and analytics teams to establish network reporting for Prime and vendor's pharmacy networks composition to assess network adequacy, contracting gaps and compliance with regulations

  • Represent Network Management department in audits and on cross-functional projects or Network Client Services initiatives

  • Perform network development, network analysis and management activities supporting strategy and network management priorities and projects

  • Ensure all contractual obligations are in adherence with company policies, regulatory compliance and legal requirements and engage with Legal and Network Management leadership in negotiating non-standard contract language with pharmacies

  • Establish, develop, and maintain relationships with chain, PSAOs and independent pharmacy providers

  • Manage all legal-to-legal correspondences between Prime and Pharmacy Providers escalating to Prime Legal Counsel as required

  • Other duties as assigned

Minimum Qualifications

  • Bachelor's degree in finance, business, management, or related field of study, or equivalent combination of education and/or related work experience; HS diploma or GED is required

  • 5 years of Network Management experience within Pharmacy Benefit Management (PBM), healthcare or other highly regulated industry; including 3 years of managed care experience in medical or pharmacy network contracting

  • Must be eligible to work in the United States without the need for work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

  • Excellent verbal and written presentation skills

  • Ability to work independently and on highly complex contract language and agreements; strong attention to detail

  • Ability to establish rapport and build relationships at all levels within an organization

  • Enhanced organizational skills with the ability to work on multiple projects simultaneously

  • Demonstrated ability to problem solve and interpret complex data; ability to analyze network information and synthesize it into meaningful information for a variety for audiences

  • Ability to work with confidential data and maintain privacy

  • Ability to evaluate and interpret policies and procedures

Preferred Qualifications

  • Master's degree in business, healthcare or related area of study

  • Pharmacy contracting experience within a PBM or other related healthcare industry

  • Knowledge of and experience within health care/PBM industry, Medicaid, Medicare and health plans

  • Familiarity with contract language and pharmacy reimbursement methodologies

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

About Prime Therapeutics

Prime Therapeutics is a pharmacy benefit management company that serves health plans, employers, and government programs. The company was founded in 1998 and is headquartered in Eagan, Minnesota. Prime Therapeutics manages prescription drug benefits for more than 30 million people across the United States. The company's services include claims processing, formulary management, and clinical programs. Prime Therapeutics is owned by 18 Blue Cross and Blue Shield health plans. In 2017, the company reported revenue of $5.3 billion.
Learn more about Prime Therapeutics
Size
4,000 employees
Industry
Founded
1990

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