Specialty Clinical Network Contracting Manager-Remote

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 this Specialty Clinical Network Contracting Manager to our Specialty Pharmacy Management 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 Specialty Clinical Network Contracting Manager (SC/NCM) is responsible for providing clinical pharmacy insight for various specialty services provided by Navitus along with the management of all applicable network pharmacy contracting, issue management, reporting, and network strategy in support of Navitus’ objectives.  The SC/NCM’s primary role is to deliver and coordinate specialty projects on schedule, within budget and scope, meeting the expectations of all stakeholders accompanied with the development, implementation, execution, and ongoing management of network pharmacy contracts and relationships with specialty clients and vendors for all lines of business. The SC/NCM will manage the operation and direction of specialty projects and will evaluate, execute, and provide ongoing oversight for network pharmacy contracts to evaluate, implement and ensure all contracts remain in compliance with all contractual obligations. This will include assisting with issues that may arise with any specialty product, network coverage needs, contract negotiations, reimbursement issues and as well as other specialty pharmacy related projects and contract initiatives across all lines of business and geographies (Commercial, Medicare and managed Medicaid).  

Is this you? Find out more below! 

How do I make an impact on my team?  

• Apply clinical knowledge in the development of specialty pharmacy services and network contracting related to high-cost specialty drugs.
• Assist in the analysis of product capacity and capabilities for managing new clients.
• Serve as a specialty pharmacy expert to clients, vendors clinical teams, sales and marketing.
• 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.
• Responsible for audits of the pharmacy contracts and any other related pharmacy performance guarantees and metrics.
• Assist in the determination of pharmacy network reimbursement pricing structures to align with organizational goals.
• Monitor market to expand network partnerships, drive enhancement and ensue quality network performance from specialty vendors.
• Guide specialty pharmacy product organization through process change strategies to provide for successful specialty pharmacy services for Navitus and Navitus clients.
• Oversee new client implementations for specialty pharmacy products and network contracting to ensure all client, and Navitus needs are successfully achieved.

What our team expects from you? 

• Licensed Pharmacist with Pharm D Degree or BS Degree from an accredited College of Pharmacy required. License must be current and unrestricted. Further pharmacy or disease certifications are helpful but not required. Possession of a valid Pharmacist license issued by the State where the pharmacy is domiciled and in all required State Board of Pharmacies necessary by the respective state to mail prescriptions into that state.
• Unrestricted licensure as a registered pharmacist by a states’ board of pharmacy required.
• Minimum of three years as a licensed Pharmacist
• Minimum 1 - 3 years PBM or Managed Care experience is highly desired.  Prior experience with managing vendors or accounts preferred.
• Product management/development or related experience is highly desired.
• Understanding of specialty pharmacy drugs including REMS and Limited Distribution Products best practices highly desired
• Clinical experience in specialty pharmacy is strongly preferred; or a combination of training, education, and experience that is equivalent to the employment standard listed above.
• Experience with CMS, Medicare, and state Medicaid regulations and guidance is 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, 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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