Pharmacy Network Provider Relations Manager

Summary

Join SmithRx, a rapidly growing Health-Tech company, as a Pharmacy Network Provider Relations specialist. You will support the Pharmacy Network Team in daily tasks, manage pharmacy relationships, onboard new pharmacies, and provide support to existing ones. This role demands close collaboration with pharmacy partners and internal teams to maintain high pharmacy satisfaction and the company's reputation. Responsibilities include identifying and recruiting pharmacies, managing contracts, assisting with network setup, auditing work, resolving issues, collaborating with cross-functional teams, creating documentation, and improving processes. The ideal candidate possesses a Bachelor’s Degree or relevant experience, strong communication and analytical skills, and familiarity with pharmacy networks and regulations. SmithRx offers competitive benefits, including health insurance, retirement plans, paid time off, and professional development opportunities.

Requirements

• Bachelor’s Degree or 8+ years of relevant work experience in managed care, pharmacy benefit management (PBM), or a similar healthcare setting is highly desirable. This can include experience in areas such as credentialing providers, provider relations, provider administration, or working with pharmacy adjudication platforms
• Proficiency in using computer software, especially MS Excel, is often required. Knowledge of formulas, macros, pivot tables, and other Excel functions can be important for data analysis and reporting tasks
• Strong networking, interpersonal, and relationship-building skills are crucial for building and maintaining positive relationships with pharmacy partners and internal cross-functional teams
• Excellent verbal and written communication skills are essential for effectively conveying information, resolving issues, and collaborating with various stakeholders
• The ability to analyze data, identify trends or patterns, and draw meaningful insights is valuable for tasks such as contract auditing, performance evaluation, and process improvement
• Strong organizational skills, attention to detail, and the ability to manage multiple priorities and meet deadlines in a fast-paced environment are important for success in this role

Responsibilities

• Identifying and recruiting pharmacies to join the network.  This involves conducting market research, negotiating contracts, and ensuring that the network includes a diverse range of pharmacy providers
• Onboard new pharmacies to Smith network by screening incoming pharmacy review for completeness of materials during credentialing process
• Managing contracts with pharmacy providers, including but not limited to reviewing performance metrics
• Assist with setting up pharmacy network structure in adjudication platform and test cases to implement the change
• Audit work to identify and process / coordinate correction of loading errors
• Audit contract loads for adherence to reporting standards
• Building and maintaining strong relationships with pharmacy providers, addressing their concerns or issues, and facilitating effective communication between the pharmacy and the organization
• Resolving any issues or conflicts that arise between the organization and pharmacy providers. This may involve investigating complaints, conducting root cause analysis, and working collaboratively with internal teams and providers to find effective solutions
• Collaborating with cross-functional teams, such as claims processing departments, to implement initiatives aimed at improving network efficiency, quality, and provider satisfaction
• Create documentation for standard operating procedures within the Pharmacy Network
• Recommend methods to improve processes used by department
• Build and maintain a database of pharmacy partners to ensure information is accurate and up to date
• Escalate pharmacy concerns internally and to help solve complex issues
• Assist with building out a Knowledge Base and contribute to our ongoing process improvement efforts

Preferred Qualifications

• Familiarity with pharmacy pricing aspects, understanding of pharmacy networks and affiliations, and knowledge of pharmacy-related regulations and compliance requirements are beneficial for this role
• The capacity to identify and resolve complex issues, escalate concerns when necessary, and recommend solutions or process improvements is beneficial
• Pharmacy Technician Certification preferred, healthcare experience required
• Self-driven and motivated with a desire to succeed in a fast-paced, changing environment

Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
• Flexible Spending Benefits
• 401(k) Retirement Savings Program
• Short-term and long-term disability
• Discretionary Paid Time Off
• 12 Paid Holidays
• Wellness Benefits
• Commuter Benefits
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Well-stocked kitchen in office locations
• Professional development and training opportunities