Pharmacy Contracting Professional 2 - Remote

Profile

Description

Humana is seeking a pharmacy contracting professional to solicit and maintain network agreements for all pharmacy lines of business. The pharmacy contracting professional 2 will be responsible for contracting efforts with PBMs, health plans, and government agencies. Key responsibilities include the review of terms and conditions including rates and fees, reporting and identification of opportunities to drive pharmacy growth and profitability.

The ideal candidate will be able to apply a thoughtful decision making process that protects the best interest or the patients we serve as well as the profitability of Humana Pharmacy. He/She/They will need to understand department, segment and organizational strategy and operating objectives including their impacts to related areas. Strong working knowledge of pharmacy claims processing or financial practices would be beneficial.

Responsibilities

Responsibilities

Initiates network contracting requests to expand Specialty, Mail-Order and Retail network participation

Documentation of core processes and procedures as needed to support team performance as well as payer requirements

Complete credentialing and revalidation documentation for agreements

Monitors pharmacy performance against payer terms and conditions or quality network measures

Completes notification and/or re-contracting with change in control, rebranding or 340B status

Engages with pharmacy personnel and plan help desks to resolve claim denials when pharmacy is listed as 'out of network'

Produces weekly reporting to reflect key program metrics

Identifies plans to pursue for network participation

Collaborates with key stakeholders to support pharmacy growth initiatives

Collaborates with legal, pharmacy analytics and pharmacy clinical programs and operations to resolve issues and drive pharmacy

Required Qualifications

Bachelor's degree

4 years of experience in a pharmacy setting OR 2 years in a network contracting/development role

Understanding of pharmacy and medical benefits related to drugs

Strong decision making ability

Strong communication skills both oral and written

Detail-oriented and organized

Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and Access

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Network contracting experience

Specialty pharmacy experience

Master's in Business Administration or related field

Process management experience

Active pharmacy tech license

Additional Information

We will require full COVID vaccination for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates, and communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email/text correspondence inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com