Medicaid Pharmacy Network Contract Manager
Prime Therapeutics - Eagan, MN

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The Medicaid Contract Specialist is responsible for developing, maintaining, supporting, and ensuring the quality of Prime’s pharmacy networks that are designed to manage drug costs while providing members with access and choice. This position drafts contract language, negotiates/implements pharmacy agreements, and maintains documentation that support network strategies with a primary focus on Medicaid markets.

Responsibilities:

· Serve as Network Management’s point person on Medicaid pharmacy provider contracting issues, minimizing risk exposure

· Assist the Provider Relations staff with drafting/developing/maintaining contract language

§ Assist Prime’s legal counsel and internal business units with contract template design

§ Develop and maintain template agreements for all product lines

§ Review and address language changes/modified text of agreements submitted to Prime by pharmacy providers and Prime’s clients

§ Maintain version control of all agreements, Pharmacy Provider Manual, and other Network Services documents /communications

§ Develops and maintains provider contracts in EMPTORIS contract management software and internal tracking documents

· Researches legal issues, regulations, and client contract business requirements

· Writes policies/procedures that supports Prime’s network strategies

· Assists with projects

· Composes communications

· Ensure pharmacy agreements and network initiatives comply with HIPAA, Medicare, Medicaid and other federal and state regulations

· Assists in the negotiation of network contracts directly with eligible pharmacies

· Identifies solutions and drafts proposals to problems identified for discussion with Prime’s legal counsel and Network Management leadership

· Assist with audit resolution processes

· Other duties as assigned

Minimum Qualifications :

· Bachelor’s degree or equivalent experience

· 1-2 years of comprehensive Medicaid experience (e.g. insurance, government program operations, managed care practices, and/or provider contracting)

· Minimum of 4 years experience in Pharmacy Benefit Management or healthcare industry

· Minimum of 3 years contracting experience

Preferred Qualifications:

· Experience with drafting contract language

· Advanced level of proficiency with MS Word

· Intermediate level of proficiency with Excel, and Access

· Experience managing and maintaining databases

· Prior work experience with process or project management

· Experience working in a fast-paced work environment

· Proven ability to work independently and collaboratively as part of an effective team

· Ability to prioritize and meet deadlines

· Pharmacy Benefit Management (PBM) pharmacy contracting experience

· Contracting for Commercial, Medicare, public-sector health care providers

· Legal training (i.e. paralegal )

· EMPTORIS contract management software experience

· Experience managing projects

· Experience with URAC standards

· Excellent written, oral, interpersonal, and team communication skills

· Strong influencing and negotiation skills

· Ability to work under ambiguity and rapid change

· Experience designing and building databases

· Experience utilizing Lotus Notes

· Training development

Prime Therapeutics

Prime's fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in the health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing and team-oriented company, apply to Prime today and start making a difference.

We are proud to be an EOE/AA employer. We maintain a drug-free and tobacco-free workplace and perform pre-employment substance abuse testing.

Prime Therapeutics - 19 months ago - save job - block
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Prime Therapeutics (Prime) is a thought leader in pharmacy benefit management. We help clients make smart health care management decisions...