Manage pharmacy contracting, contract redlines, network compliance, audits, pharmacy inquiries, claims issue resolution, communications, plan design builds, quality assurance, and claims processing. The role supports pharmacy network maintenance and government-regulatory compliance within a pharmacy benefit management environment.
CompanyNavitus
About UsNavitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.
Pay RangeUSD $48,728.61 - USD $58,010.26 /Yr.
STAR Bonus % (At Risk Maximum)5.00 - Salaried Non-Management except pharmacists
Work Schedule Description (e.g. M-F 8am to 5pm) M-F 8am to 5pm
Remote Work NotificationATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
Overview
Navitus Health Solutions is seeking a Pharmacy Relations Specialist to join our team!
The Pharmacy Relations Specialist (PRS II) is a highly motivated professional with at least 2 years of successful experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare. Responsibilities include executing contracts with pharmacies, responding to pharmacy inquiries, and completing the tactical and operational tasks required to maintain contracted pharmacy networks.
Is this you? Find out more below!
ResponsibilitiesHow do I make an impact on my team?
- Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs and assist management with network negotiations; inclusive of redline reviews
- Review pharmacy contract setup to ensure compliance with pharmacy network agreements
- Support pharmacy audits and network compliance initiatives
- Research and problem solve to resolve claim issues and concerns
- Respond to and track requests, inquiries, and communications with network pharmacies
- Develop, review, and distribute pharmacy communications to meet internal and client requests
- Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures
- Reviews and responds to independent pharmacy redlines; with little to no input from senior leadership
- Responsible for all aspects of maintenance related to pharmacy network functions, such as, network plan design builds, quality assurance measures and claims processing in general
- Other duties as assigned
What our team expects from you?
- College or 2-year Technical Degree or equivalent experience is preferred. Advanced technical education a plus
- Certified Pharmacy Technician preferred
- 3 years business-setting experience
- Retail pharmacy experience or experience in a managed care pharmacy setting desired
- Prior experience analyzing medical and/or pharmacy claims or credentials are highly desired
- Proficient in Microsoft Office and industry related software
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
#LI-Remote
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