Pharmacy Network Manager

ESSENTIAL DUTIES AND RESPONSIBLITIES include but are not limited to the following:

● Responsible for day-to-day operational support for pharmacy questions via phone and/or email.

● Responsible for Network Development emails; respond to requests and questions from pharmacies in a timely manner.

● Initiate and tracks contract from initial draft to full execution.

● Provide written and/or verbal contractual education for pharmacies as needed.

● Target and recruit additional pharmacies to meet Plan network adequacy requirements and/or requests and maintain network relationships with small independent/chain pharmacies.

● Participate in re-contracting efforts as required and directed.

● Shepherd contracts through the negotiation process for independent pharmacies and small chains and maintain relationships with those contracted entities.

● Lead Hospice Contracting initiatives.

● Update multiple systems with contract data and demographic information, as required.

● Submit pricing changes to the Quality Assurance team.

● Assist in RFP responses.

● Responsible for maintaining the Pharmacy Administrative Manual, (PAM).

● Work with the Credentialing Specialist to ensure credentialing standards are met.

● Investigate pharmacy claim issues; pricing complaints and perform Pricing Escalation triage for the network Analyst.

● Communicate with the MAC/Reimbursement team as required.

● Participate in the weekly GER review call and make changes in the system based on those reviews.

● Attend meetings for new plan implementations.

● Ensure deliverables are on time and meet quality levels as expected by ProCare’s internal and external customers.

● Coordinate and follow up on pharmacy network fax/email blasts as required.

● Responsible for oversight of monthly import reports and weekly cascading of data through various systems.

● Prepare documentation for audits, as requested by manager and support URAC accreditation.

QUALIFICATIONS AND REQUIREMENTS  

● Must be a strong team player who can adapt to a team environment and work independently in a fast-paced environment.

● Must be able to work in multiple computer systems simultaneously on a daily basis.

● Excellent telephone etiquette and verbal/written communication skills.

● Must be highly organized, motivated, take initiative and possess a willingness to learn new processes.

● Extreme attention to detail required.

● Working knowledge of computers and related software applications such as Word, Excel, Adobe and Outlook a must.

● Must be able to review contracts and learn the differences of each contract.

  EDUCATION AND EXPERIENCE  

Associate’s Degree with two years of experience in a health care setting working with contracts and/or provider relations preferred. PBM experience a plus.

PHYSICAN DEMANDS  

Requires sitting, standing, and occasional light lifting.

The Perks of Joining Our Team: 

We believe in taking care of our team.  You'll enjoy a comprehensive benefits package designed to support your well-being and financial future: 

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.


• Time to Recharge: Paid vacation and holiday pay.


• Focus on Your Wellness: We offer a robust Employee Wellness Program.


• Invest in Your Future: 401(k) with a company match.


• Support System: Employee Assistance Program provides confidential support and counseling.


• Get Rewarded for Referring Great People:  Employee referral program.

Ready to start your rewarding journey with us? Apply today! 

ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at [email protected]. 

ProCare Rx is an Equal Opportunity Employer