Pharmacy Network Management Specialist Jobs

7+ years of pharmacy benefit audit experience

7+ years working experience, preferably at a consulting firm, PBM, managed care organization, health plan, employer, or coalition / cooperative company.

Ability to engage in and contribute to strategic discussions with executive c-suite level leadership for payers in the pharmacy benefits industry

Manage small to large payer client relationships within large matrix organizations

Use pharmacy clinical and financial knowledge to diagnose and solve payer client problems.

Create and execute a marketing strategy to grow CMH Health’s pharmacy benefit audit services.

Execute and implement dynamic pricing strategies in response to market fluctuations to provide competitive, profitable, and best of class pricing offerings

Extensive PBM industry knowledge and deep understanding of the financial levers of a PBM

Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, Life insurance

Integrity: Do the right thing. Especially when it's hard.

Together: Build bridges and lift up your colleagues.

Perform other job-related duties as assigned

Position: Pharmacy Network Management Specialist

·Previous customer service experience in a managed care environment.

REQUIRED 3-5 years pharmacy network experience.

·Suspend/ remove pharmacies from the network not meeting contracted and credentialing requirements.

·Manage and monitor each client network structure with the Pharmacy Network database, SNA and claims processing system.

·Understanding of URAC and CMS network requirements.