Specialist II, Pharmacy Relations

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

📋 Description

• Oversee the pharmacy contracting process with independent pharmacies and selected chains/PSAOs.

• Aid management in network negotiations, including conducting redline reviews.

• Examine pharmacy contract setups to ensure adherence to pharmacy network agreements.

• Assist with pharmacy audits and initiatives for network compliance.

• Investigate and resolve issues and concerns related to claims.

• Address and monitor requests, inquiries, and communications with network pharmacies.

• Create, review, and distribute communications for pharmacies related to internal and client requests.

• Track, monitor, and report on pharmacy compliance with government regulations as well as internal policies and procedures.

• Review and respond to independent pharmacy redlines with minimal input from senior leadership.

• Maintain the functions of the pharmacy network, including designing network plans, quality assurance measures, and claims processing.

• Carry out additional duties as assigned.

⛳️ Requirements

• A minimum of 2 years of successful experience in a pharmacy or direct interaction with pharmacies or accounts, ideally in healthcare.

• A college degree or a 2-year Technical Degree, or equivalent experience is preferred.

• Advanced technical education is an advantage.

• Certification as a Pharmacy Technician is preferred.

• At least 3 years of experience in a business setting.

• Experience in retail pharmacy or managed care pharmacy settings is desired.

• Previous experience in analyzing medical and/or pharmacy claims or credentials is highly preferred.

• Proficient in Microsoft Office and software related to the industry.

• Engage in, adhere to, and support compliance program objectives.

• Ability to consistently interact cooperatively and respectfully with colleagues.

• Residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming are not eligible for remote work.

🏝️ Benefits

• Competitive benefits for Health, Dental, and Vision insurance.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan.

• Support for Professional Memberships.

• Referral Bonus Program – up to $750.