Provider Contracting Manager jobs in Madison, WI

The Network Contracting Manager will be responsible for the management of retail, specialty, and mail order pharmacy contracting, issue management, reporting, and network strategy in support of Navitus’ objectives.   The primary responsibility is to develop, implement, execute, and provide ongoing management of pharmacy contracts and relationships with pharmacy partners, including national and regional chain providers, pharmacy services administration organizations (PSAOs) and independent pharmacies for all lines of business. 

The Network Contracting Manager will evaluate the value obtained from each pharmacy contract on behalf of Navitus and payers and will be responsible to ensure compliance with all contractual obligations of such contracts.  The Network Contracting Manager assists with addressing reimbursement issues, determining network needs, evaluating prospective providers, managing all pharmacy and vendor contract negotiations as well as other pharmacy related projects and initiatives across all lines of business and geographies (Commercial, Medicare and managed Medicaid).  The Network Contracting Manager will work across multiple departments to fulfill the responsibilities of this role with respect to retail, mail, specialty, and other pharmacy services including necessary administrative duties required to maintain compliance with all state and federal regulations.

Is this you? Find out more below! 

How do I make an impact on my team?  

• Negotiate pharmacy network reimbursement ethically in support of Navitus’ mission to meet or exceed clients’ and Navitus’ needs for all lines of business and programs, including Commercial, Medicare Part D, Managed Medicaid, Exchanges, and Narrow Retail, Specialty, and Mail Order Networks.
• Ongoing management of pharmacy network contracts, including timely renewals and updating of financial and legal terms in such contracts.
• Negotiate and execute pay for performance program-specific contracts with pharmacies.
• Ensure all Pharmacy Networks comply with applicable regulatory entities and contractual obligations that relate to Value-Based, Quality, and Performance Network initiatives.
• Work with clinical teams to identify possible quality measures applicable to pharmacy services for each line of business.
• Responsible for audits of the pharmacy quality performance network and any other related pharmacy performance guarantees and metrics.
• Participate and manage project objectives and timelines to assist with network contracting action items and tasks that better serve the network contracting needs of the organization.  
• Assist in the interpretation of data models to establish market competitive pricing to secure new/retained business.
• Assist in the determination of pharmacy network reimbursement pricing structures to align with organizational goals.
• Consult with Provider Services Informatics in the construction of market appropriate network design for new business prospects and existing clients.
• Develop value proposition to payers for preferred, narrow, specialty, and limited distribution pharmacy networks.
• Ensure compliance with all applicable regulatory entities and contractual obligations that relate to network contracting initiatives and ensure all Participating Pharmacy contracts comply with government regulations and statutes.
• Serve as Pharmacy Network Subject Matter Expert backup for key new client implementations.

What our team expects from you? 

• Bachelor’s degree or higher in a related field is preferred.
• Minimum 1 - 3 years PBM or Managed Care experience is highly desired.  
• Prior experience with managing vendors or accounts preferred.
• Understanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desired.
• Experience with CMS, Medicare, and state Medicaid regulations and guidance is preferred.
• Knowledge of health care processes and pharmaceutical claims adjudication systems.
• 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