Pharmacy Network Consultant Sr.

About the role

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. The Pharmacy Network Consultant Sr. is responsible for development and management of Prime's retail, mail, specialty, and quality-based pharmacy networks. This position manages network vendor contracting activities, ensuring initiatives align with Prime's Supply Chain Cost of Goods Sold (COGS) and network management strategies. It also represents Network Management in financial audits and cross-functional projects.

Responsibilities

• Negotiate market-competitive, low to medium-high complexity pharmacy agreements for assigned pharmacies across all channels (retail, mail, specialty, and quality-based) and lines of business aligned to Supply Chain COGS strategies and compliant with Network Management policies.
• Create and manage network contracting campaigns with network vendors; analyze information and report contracting performance to Network Management leadership, Network Client Services, Network Financial Analytics, Supply Shared Services, Pharmacy FWA and Audit, and others 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 pharmacy networks to assess network adequacy, contracting gaps, and compliance with regulations.
• Represent the Network Management department in audits and on cross-functional projects or Network Client Services initiatives.
• Perform network development, analysis, and management activities supporting strategy and network management priorities and projects.
• Ensure all contractual obligations adhere to company policies, regulatory compliance, and legal requirements. 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.

Requirements

• 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.

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 of 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 the healthcare/PBM industry, Medicaid, Medicare, and health plans.
• Familiarity with contract language and pharmacy reimbursement methodologies.

Pay

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

Benefits

To review our Benefits, Incentives, and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.