Senior Pharmacy Network Consultant

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

📋 Description

• Negotiate competitive pharmacy agreements within retail, mail, specialty, and quality-focused channels and lines of business.

• Develop and oversee network contracting campaigns in collaboration with the network vendor.

• Analyze contractual data and present performance reports to Network Management leadership and cross-functional teams.

• Implement network reporting to evaluate network adequacy, identify contracting gaps, and ensure regulatory compliance.

• Act as a representative for Network Management in audits and collaborative projects.

• Conduct network development, analysis, and management activities aligned with strategic objectives and priorities.

• Guarantee that contractual commitments adhere to company policies, regulatory standards, legal obligations, and Network Management guidelines.

• Negotiate atypical contract language with pharmacies in partnership with Legal and Network Management leadership.

• Build, nurture, and sustain relationships with chain, PSAO, and independent pharmacy providers.

• Manage legal correspondence between Prime and pharmacy providers, escalating issues to Prime Legal Counsel when necessary.

• Carry out other assigned responsibilities.

⛳️ Requirements

• A Bachelor's degree in finance, business, management, or a related discipline, or an equivalent combination of education and/or relevant work experience.

• A high school diploma or GED is required.

• Minimum of 5 years of experience in Network Management within a PBM, healthcare, or similarly regulated industry.

• At least 3 years of managed care experience focused on medical or pharmacy network contracting.

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

• Exceptional verbal and written communication skills.

• Capability to work independently on highly intricate contract language and agreements.

• Strong attention to detail.

• Proficient in building rapport and fostering relationships across all levels of the organization.

• Enhanced organizational abilities and the capacity to manage multiple projects concurrently.

• Proven problem-solving skills.

• Ability to interpret complex data and analyze network-related information.

• Capacity to synthesize information for diverse audiences.

• Skilled in handling confidential data while ensuring privacy.

• Ability to assess and interpret policies and procedures.

• Preferred: Master's degree in business, healthcare, or a related field.

• Preferred: Experience in pharmacy contracting within a PBM or related healthcare sector.

• Preferred: Familiarity with the healthcare/PBM industry, Medicaid, Medicare, and health plans.

• Preferred: Understanding of contract language and pharmacy reimbursement methodologies.

• Must adhere to job-specific security responsibilities, controls, legal, regulatory, contractual, and internal policy requirements.

• Must be capable of performing essential job functions, with reasonable accommodations available when applicable.

🏝️ Benefits

• Benefits, incentives, and additional compensation options are available; candidates can refer to Prime’s Benefits Page for further details.

• Reasonable accommodations are provided for employees with disabilities.

• Tobacco-Free Workplace.