Pharmacy Contracting Professional

Profile

Description

CenterWell Pharmacy is seeking a pharmacy contracting professional to solicit and maintain network agreements for all pharmacy lines of business. The pharmacy contracting professional 2 will be responsible for contracting efforts with PBMs, health plans, and government agencies. Key responsibilities include the review of terms and conditions including rates and fees, reporting and identification of opportunities to drive pharmacy growth and profitability.

The ideal candidate will be able to apply a thoughtful decision making process that protects the best interest or the patients we serve as well as the profitability of Humana Pharmacy. He/She/They will need to understand department, segment and organizational strategy and operating objectives including their impacts to related areas. Strong working knowledge of pharmacy claims processing or financial practices would be beneficial.

Responsibilities

Responsibilities


Initiates network contracting requests to expand Specialty, Mail-Order and Retail network participation
Documentation of core processes and procedures as needed to support team performance as well as payer requirements
Complete credentialing and revalidation documentation for agreements
Monitors pharmacy performance against payer terms and conditions or quality network measures
Completes notification and/or re-contracting with change in control, rebranding or 340B status
Engages with pharmacy personnel and plan help desks to resolve claim denials when pharmacy is listed as 'out of network'
Produces weekly reporting to reflect key program metrics
Identifies plans to pursue for network participation
Collaborates with key stakeholders to support pharmacy growth initiatives
Collaborates with legal, pharmacy analytics and pharmacy clinical programs and operations to resolve issues and drive pharmacy


Required Qualifications


Bachelor's degree
2 years of experience in a pharmacy setting OR 2 years in a network contracting/development role
Understanding of pharmacy and medical benefits related to drugs
Strong decision making ability
Strong communication skills both oral and written
Detail-oriented and organized
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and Access
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Network contracting experience
Specialty pharmacy experience
Master's in Business Administration or related field
Process management experience
Active pharmacy tech license


Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email/text correspondence inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from **** with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

Company info

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