Pharmacy Network Consultant – Principal

Job Description:

  • Negotiate market competitive high-profile and/or complex pharmacy agreements across all channels including retail, mail, and quality based and lines of business aligning with Supply Chain COGS strategies
  • Lead and implement network initiatives by facilitating and performing network analyses, contracting activities and fee schedule development aligning with strategy, priorities and projects goals
  • Partner with Prime's reporting and analytics teams to develop network vendor loading rules inclusive of approved preferred pharmacies; maintain key compliance criteria and implement quarterly reporting processes for all contracted network retail pharmacies
  • Analyze network retail pharmacy quarterly reports to ensure compliance with reporting and participation requirements; collaborate with Clinical Program Directors to identify potential performance gaps; work with internal and external partners to develop and manage corrective action plans
  • Responsible for effectively managing the pharmacy contract from negotiation of all terms, ensuring Prime and Pharmacy compliance and document retention aligning with Prime's Record Information Management (RIM) policies
  • Work closely with Prime's legal team to update contract documents including agreements and applications for utilization in contracting/re-contracting activities based on new network participation requirements
  • Other duties as assigned

Requirements:

  • Bachelor's degree in business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
  • 8 years of Network Management experience within Pharmacy Benefit Management (PBM), healthcare or other highly regulated industry; including 5 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
  • Excellent verbal and written presentation skills
  • Demonstrated understanding of network reporting and analysis for specialty pharmacy
  • Demonstrated ability to establish trust and credibility; form working relationships with all levels of an organization
  • Demonstrated ability to work independently and on highly complex contract language and agreements; strong attention to detail
  • 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.

Benefits:

  • Health insurance
  • 401(k) matching
  • Paid time off
  • Remote work options
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