Network Management Consultant

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
- Job Posting Title

Network Management Consultant
- Job Description
- The Network Management Consultant is responsible for development, performance and management of Prime’s retail, mail, specialty, and quality-based networks aligning with Prime’s Supply Chain Cost of Goods Sold (COGS) and network management strategies. This includes development of network contracts, participation requirements, analysis of pharmacies, and ensuring contract and regulatory compliance. This position is accountable for creation and management of specialty fee schedules to ensure competitiveness and serves as the liaison between Prime’s Network Management and Specialty teams.
- Responsibilities
- Negotiate market competitive high-profile and/or complex pharmacy agreements across all channels including retail, mail, specialty and quality based and lines of business aligning with Supply Chain COGS strategies Lead and manage specialty fee schedule development process and ensure fee schedule revisions align with Supply Chains COGS strategies for specialty drug management
- Lead and implement network initiatives by facilitating and performing network analyses, contracting activities and fee schedule development aligning with strategy, priorities and projects goals
- Partner with Prime’s reporting and analytics teams to develop network vendor loading rules inclusive of approved preferred and specialty pharmacies; maintain key compliance criteria and implement quarterly reporting processes for all contracted network specialty pharmacies
- Analyze network specialty pharmacy quarterly reports to ensure compliance with reporting and participation requirements; collaborate with Specialty Clinical Program Directors to identify potential performance gaps; work with internal and external partners to develop and manage corrective action plans
- Responsible for effectively managing the pharmacy contract from negotiation of all terms, ensuring Prime and Pharmacy compliance and document retention aligning with Prime’s Record Information Management (RIM) policies
- Other duties as assigned
- Minimum Qualifications
- Bachelor’s degree in business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
- 8 years of Network Management experience within Pharmacy Benefit Management (PBM), healthcare or other highly regulated industry; including 5 years of managed care experience in medical or pharmacy network contracting
- Must be eligible to work in the United States without need for work visa or residency sponsorship
- Additional Qualifications
- Excellent verbal and written presentation skills
- Demonstrated understanding of network reporting and analysis for specialty pharmacy
- Demonstrated ability to establish trust and credibility; form working relationships with all levels of an organization
- Demonstrated ability to work independently and on highly complex contract language and agreements; strong attention to detail
- Enhanced organizational skills with the ability to work on multiple projects simultaneously
- Demonstrated ability to problem solve and interpret complex data; ability to analyze network information and synthesize it into meaningful information for a variety for audiences
- Ability to work with confidential data and maintain privacy
- Preferred Qualifications
- Master’s degree in business, healthcare or related area of study
- Demonstrated understanding of retail and specialty network fee schedule management
- 2 years of experience in specialty contracting
- Minimum Physical Job Requirements
- Ability to travel up to 15% of the time
- Constantly required to sit, use hands to handle or feel, talk and hear
- Frequently required to reach with hands and arms
- Occasionally required to stand, walk and stoop, kneel, and crouch
- Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
- Reporting Structure
- Reports Director in Network Management department

Potential pay for this position ranges from $104,700.00 - $167,300.00 based on location, experience and skills.

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- Benefits Page

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