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Specialist II, Pharmacy Relations-Remote - Madison, WI, US | Remote, US

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.  

We are 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.

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.

The individual(s) in this position are responsible for provider relations and is the face of Navitus to our pharmacy providers.  The individual(s) will also support internal associates, such as customer care and client services, to ensure pharmacies adjudicate pharmacy claims according to Navitus agreements and Navitus business rules.  As part of the daily responsibilities, this position is responsible for establishing contracts with pharmacy providers, recording data with a high level of accuracy, researching pharmacy inquiries, and reporting performance metrics.  In addition, the coordinator develops efficiencies in current and future processes within the department and in how the department works with other Navitus teams.   

Is this you? Find out more below! 

How 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
  • Implement changes to ensure compliance with all company policies and procedures as well as regulatory requirements.
  • Research and problem solve to resolve claim issues and concerns.
  • Respond to and track requests, inquiries, and communications with network pharmacies.
  • Collaborate with cross-functional teams on pharmacy-related matters.
  • Develop, review, and distribute pharmacy communications to meet internal and client requests.
  • Investigate specific issues related to regulatory requirements through literature or internet resources.
  • 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.

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?

  • Hours/Location: Monday-Friday 8:30am-5:00pm CST, Remote
  • Paid Volunteer Hours
  • Educational Assistance Plan and Professional Membership assistance
  • Referral Bonus Program – up to $750!
  • Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program

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Job Profile

Regions

North America

Countries

United States

Benefits/Perks

Adoption Assistance Adoption Assistance Program College Savings Plan Educational Assistance Educational Assistance Plan Employee Assistance Program Flexible Spending Flexible Spending Account Nine paid holidays Paid parental leave Paid Time Off Paid Volunteer Hours Professional Membership assistance Referral Bonus Referral Bonus Program Remote work

Skills

Claims processing Client Services Compliance Compliance monitoring Contract management Customer service Data analysis Design Leadership Managed Care Microsoft Office Pharmacy Pharmacy operations Quality Assurance Research Retail pharmacy

Tasks
  • Collaborate with cross functional teams
  • Develop and distribute pharmacy communications
  • Ensure compliance
  • Maintain pharmacy network functions
  • Manage pharmacy contracting process
  • Monitor pharmacy compliance
  • Resolve claim issues
  • Respond to pharmacy inquiries
  • Review contract setup
  • Support audits and compliance initiatives
Experience

2 years

Education

Associates Business College Communications Healthcare Pharmacy Technical degree

Certifications

Certified Pharmacy Technician

Restrictions

Remote work not available in specified states Residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming

Timezones

America/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9