Pharmacy Network Consultant – Principal

This is a fully remote position, open to applicants in United States.

📋 Description

• Negotiate competitive, high-profile, and/or intricate pharmacy agreements across various channels including retail, mail, and quality-based lines of business, in alignment with Supply Chain COGS strategies.

• Lead and execute network initiatives by conducting network analyses, engaging in contracting activities, and developing fee schedules that align with strategic priorities and project goals.

• Collaborate with Prime's reporting and analytics teams to establish network vendor loading rules, incorporating approved preferred pharmacies; ensure adherence to key compliance criteria and implement quarterly reporting processes for all contracted network retail pharmacies.

• Review network retail pharmacy quarterly reports to verify compliance with reporting and participation standards; work with Clinical Program Directors to pinpoint potential performance gaps and collaborate with internal and external partners to create and oversee corrective action plans.

• Oversee the management of pharmacy contracts from term negotiation to ensuring compliance with Prime and Pharmacy policies, including document retention in accordance with Prime's Record Information Management (RIM) guidelines.

• Collaborate closely with Prime's legal team to revise contract documents, including agreements and applications, for use in contracting and re-contracting activities based on updated network participation requirements.

• Additional responsibilities as assigned.

⛳️ Requirements

• Bachelor's degree in business or a related field, or an equivalent combination of education and/or relevant work experience; a high school diploma or GED is mandatory.

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

• Must possess eligibility to work in the United States without requiring a work visa or residency sponsorship.

• Exceptional verbal and written communication skills.

• Proven understanding of network reporting and analysis for specialty pharmacy.

• Demonstrated capacity to build trust and credibility; foster working relationships at all organizational levels.

• Proven ability to work independently on highly complex contract language and agreements; strong attention to detail is essential.

• Advanced organizational skills with the capacity to manage multiple projects simultaneously.

• Demonstrated proficiency in problem-solving and interpreting complex data; ability to analyze network information and translate it into valuable insights for diverse audiences.

• Capability to handle confidential data while maintaining privacy.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Paid time off

• Remote work options