Sr. Pharmacy Network Representative

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.

Please note while this job description is a comprehensive overview, additional responsibilities may be part of the role.

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 email us at [email protected]. 

ProCare Rx is an Equal Opportunity Employer.