This role involves conducting quality and service level management with external pharmacy providers to ensure contractual alignment, executing pharmacy network strategy, and managing provider costs, focusing heavily on Cost of Goods Sold reduction. Responsibilities also include ensuring consistent service to clients, vetting provider viability, and facilitating database maintenance for preferred pharmacies.
Requirements summary
Candidates need a Bachelor's Degree or equivalent experience, with at least one year in pharmaceutical contracting and pricing, including development and implementation. Strong financial acumen, excellent communication skills, and the ability to work independently are required, with experience in managed care or PBM strongly preferred.
The essential duties and primary accountabilities below are intended to describe the general content and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent’s performance objectives as outlined by the incumbent’s immediate supervisor or manager.
1.
Conducts quality and service level management with the external pharmacy providers to align with contractual requirements and client expectations.
This includes service level reviews and education, PAR level inventory compliance reviews and consultation, market and provider performance improvement plans, and Client Services business review support.
2.
Executes a pharmacy network strategy aligned with Company goals, including preparing and delivering related presentations and management reporting as directed by Pharmacy Network Management leadership.
3.
In collaboration with Pharmacy Network leadership, provider strategy with the overall goal of aligning the Provider Network costs to market pricing, placing importance on Cost of Goods Sold (COGS) management and reduction.
4.
Ensures a consistent level of service and support to Clients and the Provider Network while executing on a pharmacy network of preferred Dragonfly Health providers, including providing access to quality providers and specialty services.
This includes oversight of Provider Network planning to ensure the Network has enough viable Pharmacy Provider options in all markets, manages and reduces risk of volume overleveraging with Providers, properly aligns contractual terms to protect the business from external influences, vets current and prospective Provider’s ability and viability to meet service level agreements, and increase the number of viable Pharmacy Providers in the Network.
5.
Facilitates the creation and maintenance of a database of preferred local pharmacies and available network pharmacies.
6.
Collaborate with and assist the Dragonfly Health compliance team to ensure compliance with state legislative requirements in areas relating to the functions of the position.
7.
In collaboration with Pharmacy Network leadership, assist in the orientation and training of pharmacy network operations team members.
8.
Utilize template documents for contracting with pharmacy providers and suggest edits for approval as part of the negotiation process with the pharmacy providers.
9.
Facilitate internal pricing reviews for individual claims submissions between MAC appeals team and network pharmacy providers.
10.
Facilitate the programming of negotiated pharmacy provider rates per contract and complete the audit of the loaded pharmacy provided rates on all contracts.
Marginal or Additional Functions
1.
Acts as a resource for cross-functional departments to address and resolve challenges and provide effective provider solutions.
2.
Acts as a subject matter expert and leads with a positive attitude to foster a constructive and productive work atmosphere.
Puts an emphasis on a need for “team” mindset demonstrated through action.
3.
Performs other duties as assigned or apparent.
Supervisory and Managerial Responsibility
Role has no supervisory or managerial oversight
Knowledge, Skills & Abilities
Education, Licensure or Certification
• Bachelor’s Degree or equivalent work experience
Work Experience or Related Experience
1+ years of experience in pharmaceutical contracting and pricing including development, implementation, and maintenance.
Demonstrated experience collaborating with vendors to resolve issues and deliver proactive, high quality onboarding, along with administrative skills in analytics and information presentation.
Customer support, relationship management, and/or direct vendor management experience preferred.
Experience in healthcare or medical fields in which incumbents have gained an understanding of pharmacy benefit management is strongly preferred
Experience contracting with retail, compounding, infusion and specialty pharmacies
Specialized Knowledge, Skills & Abilities
Hospice and palliative care experience
Knowledge of NCPDP Pharmacy Processing Standards
Operational experience in managed care, PBM, or network management is strongly preferred
The ability to effectively and efficiently execute operational directives as normally obtained by progressively responsible service-related experience in which the candidate executed operations strategies and initiatives
Strong financial acumen with proficiency in analyzing and interpreting data
A high level of professionalism, customer service and discretion are required to represent the organization and interact with other stakeholders (internal and external) as described
Demonstrates excellent listening skills along with exceptional verbal and written communication capabilities.
Ability to work independently and multitasking is necessary for successful completion of daily responsibilities
Strong professional communication, presentation and interpersonal skills are required
Ability to maintain confidentiality, and to exercise discretion and good judgment
Equipment
• Demonstrates strong computer proficiency across standard business and communication software is required.
Travel Requirements and Conditions
Limited travel as necessary - not expected to exceed 10%
Work Environment, Conditions and Demands
Work is generally performed in an office environment or remote setting in which there is only minimal exposure to unpleasant and/or hazardous working conditions.
Physical Requirements and Demands
Note
Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions as described.
