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Do you want to make a large impact in your next role? Join Company, a Fortune 5 company, as the Pharmacy Provider Network Development Director. In this high impact role, you will have responsibility for the development of strategies regarding any contracting, implementation or maintenance of networks for Caremark commercial and Medicaid managed care clients.
Develop innovative networks and pharmacy programs to control pharmaceutical costs, achieve client expectations and ensure member access to medications
Collaborate with teams within Network Services to ensure the alignment of strategy and direction.
Provide pricing direction, provide solutions for successful commercial and Medicaid network contracting with providers and implement these solutions.
Negotiate directly with pharmacy providers.
Provide support to and lead cross-functional teams as necessary to facilitate the implementation of networks and products and provide QA support for the implementation.
Provide oversight and maintenance of ongoing operations, monitor and evaluate results.
Provide support for issue resolution for claims processing issues (which may involve new contracting strategies).
Ensure regulatory compliance, provide subject matter expertise in the areas of relevant regulatory policies, contractual obligations and legal considerations.
Recognize and understand the significance of issues that may be regulatory or legal considerations.
Develop and maintain relationships with key network providers to facilitate the development of networks and programs to support Company clients.
Monitor the competitive environment to anticipate future trends and to identify key industry drivers. Report observations and insights to leadership.
Here, you will be an integral member of the team. You will have the opportunity to identify unique areas for growth and leverage relationships to promote PBM programs to grow the business and increase revenue. Your demonstrated ability to deal with pharmacy owners as well as chain and PSAO management, as well as your ability to efficiently managing multiple ongoing negotiations will be critical to your success.
The ideal candidate will have experience with PBM pharmacy network contracting and knowledge of legal and regulatory concepts required include contracting addendum, amendment, network enrollment form structure and creation. Your assertive nature, strong communication and presentation skills, ability to make decisions independently, and expertise in Microsoft Office applications, especially Excel, will also be key.
Join the company helping people on their path to better health! Our organization offers a competitive benefit package including vacation and holiday paid time off, health/dental/vision insurance, work/life balance, employee discounted stock purchase program, 401K, tuition reimbursement, and employee discounts at all Company stores.
- Experience in healthcare industry including drug therapy, retail pharmacy operations, third party contracting or managed healthcare required.
- Experience with healthcare or pharmacy network contracting required.
- BS in Pharmacy or PharmD preferred
- Experience with pharmacy claims adjudication systems and adjudication processes and claims reimbursement.
Bachelor's degree required.
It’s a new day in health care.
Combining Company and Aetna was a transformative moment for our company and our industry, establishing Company as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a Company colleague, you’ll be at the center of it all.
At Company, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, Company colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
Company is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for Company job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team.
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