Provider Contracting Manager jobs in Appleton, WI

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.  

Due to growth, we are adding a Sr. Analyst, Network Contracting to our Provider Services Department.

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 Senior Analyst, Network Contracting will be responsible for the financial management of retail, specialty, and mail order pharmacy contracting, issue management, and reporting, in support of the network strategy to deliver value to Navitus clients.   The primary responsibilities of this role are to analyze current and new pharmacy contracts and provide support for all phases of the pharmacy contracting process, including national and regional chain providers, pharmacy services administration organizations (PSAOs) and independent pharmacies for all lines of business.

 The Network Contracting Senior Analyst will analyze contract alternatives to support Network Contracting retail and specialty teams and lead analysis of negotiated contracts to maximize return and mitigate risks. The Network Contracting Senior Analyst will provide clear data summaries to explain reimbursement, network needs, and industry trends to support pharmacy and vendor contract negotiations across all lines of business and geographies (Commercial, Medicare and managed Medicaid). This position will be expected to work cross functionally with internal and external partners including clients, vendors, and pharmacy partners to deliver value to Navitus clients through our pharmacy contracts. 

Is this you? Find out more below! 

How do I make an impact on my team?  

• Support the network contracting management division by preparing contracting and strategy analytics, including new contracts and contract renewals.
• Assist with preparation and attend meetings with strategic pharmacy partners.
• Plan, design, and deploy appropriate reports, tools, and/or applications.
• Provide support with pharmacy data and topic preparation for industry conferences, including scheduling.
• Prepare analyses covering provider agreements, 340B opportunities, mail order, discount card, specialty, and any related needs.
• Complete complex analysis to monitor the value of contracts and strategic initiatives of Navitus.
• Collaborate with Contract Managers, Finance, Pharmacy Informatics, Legal and other internal business divisions to make recommendations to financial models and assist with the development of financial contract solutions.
• Prepare forward-looking network analytics, ensuring alignment of planned actions and targets in the forecast.
• Proactively monitor industry trends including acquisition cost, competitive intel, and innovative program offerings.
• Complete ad hoc analyses and assist with special projects as directed by retail and specialty supervisors.

What our team expects from you? 

• Bachelor’s degree in finance, accounting, business, actuarial science or related field is preferred.
• Minimum three years of database management experience
• Experience in business, finance, or analytics
• Minimum three years experience in Retail Pharmacy and/or Pharmacy Benefit Management (PBM) or Managed Care
• Experience with Pharmacy Benefit Management (PBM), contracting and pharmacy industry/technical terms, pricing and processes
• Experience with CMS, Medicare, and state Medicaid regulations and guidance preferred.
• Knowledge of health care processes and pharmaceutical claims adjudication systems preferred
• 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 8:00am-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, Eight paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program