Sr. Pharmacy Network Representative

ESSENTIAL DUTIES AND RESPONSIBLITIES

Responsibilities include day-to-day operational support for pharmacy questions via phone and/or email, Network Development email support, contract initiation and execution, contractual education for pharmacies, target pharmacy recruitment, re-contracting participation, contract negotiation shepherding, hospice contracting leadership, system updates, pricing change submission, RFP assistance, Pharmacy Administrative Manual maintenance, credentialing standard assurance, claim issue investigation and pricing escalation triage, MAC/Reimbursement communication, weekly GER review participation, new plan implementation attendance, quality deliverable oversight, pharmacy network communication coordination, monthly import report oversight, audit documentation preparation, and URAC accreditation support.

• Responsible for day-to-day operational support for pharmacy questions via phone and/or email.
• Responsible for Network Development emails; respond to requests and questions from pharmacies in a timely manner.
• Initiate and tracks contract from initial draft to full execution.
• Provide written and/or verbal contractual education for pharmacies as needed.
• Target and recruit additional pharmacies to meet Plan network adequacy requirements and/or requests and maintain network relationships with small independent/chain pharmacies.
• Participate in re-contracting efforts as required and directed.
• Shepherd contracts through the negotiation process for independent pharmacies and small chains and maintain relationships with those contracted entities.
• Lead Hospice Contracting initiatives.
• Update multiple systems with contract data and demographic information, as required.
• Submit pricing changes to the Quality Assurance team.
• Assist in RFP responses.
• Responsible for maintaining the Pharmacy Administrative Manual, (PAM).
• Work with the Credentialing Specialist to ensure credentialing standards are met.
• Investigate pharmacy claim issues; pricing complaints and perform Pricing Escalation triage for the network Analyst.
• Communicate with the MAC/Reimbursement team as required.
• Participate in the weekly GER review call and make changes in the system based on those reviews.
• Attend meetings for new plan implementations.
• Ensure deliverables are on time and meet quality levels as expected by Pro Care’s internal and external customers.
• Coordinate and follow up on pharmacy network fax/email blasts as required.
• Responsible for oversight of monthly import reports and weekly cascading of data through various systems.
• Prepare documentation for audits, as requested by manager and support URAC accreditation.

• Must be a strong team player who can adapt to a team environment and work independently in a fast-paced environment.
• Must be able to work in multiple computer systems simultaneously on a daily basis.
• Excellent telephone etiquette and verbal/written communication skills.
• Must be highly organized, motivated, take initiative and possess a willingness to learn new processes.
• Extreme attention to detail required.
• Working knowledge of computers and related software applications such as Word, Excel, Adobe and Outlook a must.
• Must be able to review contracts and learn the differences of each contract.

Associate’s Degree with two years of experience in a health care setting working with contracts and/or provider Relations Preferred. PBM Experience a Plus.

Requires sitting, standing, and occasional light lifting.

Please note while this job description is a comprehensive overview, additional responsibilities may be part of the role.

Pro Care Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please email us at

Pro Care Rx is an Equal Opportunity Employer.