Description:
GENERAL SUMMARY
Responsible for leading joint pharmacy network contracting efforts with both our Network Pharmacies and the Pharmacy Benefit Manager. Leads strategy and negotiations for development of preferred, restricted and broad networks for all lines of business, including the new commercial exchange product. Works with preferred providers to benchmark and improve performance in various areas of quality. Provides contractual language drafts, fiscal responsibility and contracting modalities for all pharmacy channel pricing for injectables and specialty pharmacy products, and contract terms and conditions. Manages the review and analysis of various pharmacy contracting approaches to assess their relative financial value and yield. Manages the injectable, biotech, and specialty pharmacy provider contracting, communications, and implementation and operational plans. Provides reporting concerning the retail pharmacy contracting and specialty pharmaceutical contracting.
ESSENTIAL RESPONSIBILITIES
Negotiates rates, terms and conditions of pharmacy network contracts in joint partnership with the PBM.
Develops recommendations on pharmacy network market potentials, pricing strategies, and tactics to best capture the value throughout the life of the contract.
Develops preferred network strategies to extract greatest value.
Strategizes and evaluates value of programs such as retail 90 on mail order pricing and penetration rates, negotiations for the development of our preferred, restricted and broad networks for all lines of business, including the new commercial exchange product.
Establishes a consultative relationship with pharmacy management to develop and support effective pharmacy price governance, contract language, pricing requirements and guidelines, and implementation of network communications to Coventry’s membership.
Acts as a liaison with various internal departments and management (i.e., Pharmacy Directors, Actuarial, Legal, PBM) in order to provide both contractual language and guidance on pharmacy network utilization and trends. Delivers comparison financial models for each pharmacy contract to internal customers.
Works closely with Sales, Account Management, and General Managers of our multiple lines of business (Commercial, Medicare, Medicaid) to identify network composition strategies and contracting scenarios.
Provides fiscal analysis and counsel in support of activities to increase formulary compliance and submission of cash based product (i.e., $4 programs) to assist with improved Medicare Star ratings.
Identifies contracting elements that work and determines how Coventry can capitalize on these with other vendors.
Enhances relationships with external contacts in the pharmacy network.
Manages the contracts and negotiates prices for injectables and specialty pharmacy products with specialty pharmacy providers.
Collaborates with the Actuarial department to develop and implement financial models for self-injectable contracting comparisons.
Maintains, monitors, and audits current network rates with the PBM to confirm appropriate reimbursement rates are being applied to each contracted retail pharmacy, and jointly negotiates contracts with the retail pharmacies.
Consults with the retail pharmacies on their ability to implement new formulary decisions or national contracting strategies.
Works with our preferred providers to benchmark and improve performance in various areas of quality.
Qualifications:
JOB SPECIFICATIONS
Bachelor’s degree or equivalent experience. Master’s degree preferred.
Substantial (10-15 years) experience in pharmacy contracting. Substantial knowledge of managed care pharmacy and/or PBM pharmacy networks. Five (5) of more years of PBM operations or related experience.
Advanced general knowledge of databases, spreadsheets and information systems.
Strong analytical, communication, and negotiation skills. Strong problem-solving abilities.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: , , US
Other Locations: ,
Organization: 10250 - Coventry Prescription Mgt Svcs
Schedule: Full-time
Job Posting: 2013-04-26 00:00:00.0
Job ID: 1311561
GENERAL SUMMARY
Responsible for leading joint pharmacy network contracting efforts with both our Network Pharmacies and the Pharmacy Benefit Manager. Leads strategy and negotiations for development of preferred, restricted and broad networks for all lines of business, including the new commercial exchange product. Works with preferred providers to benchmark and improve performance in various areas of quality. Provides contractual language drafts, fiscal responsibility and contracting modalities for all pharmacy channel pricing for injectables and specialty pharmacy products, and contract terms and conditions. Manages the review and analysis of various pharmacy contracting approaches to assess their relative financial value and yield. Manages the injectable, biotech, and specialty pharmacy provider contracting, communications, and implementation and operational plans. Provides reporting concerning the retail pharmacy contracting and specialty pharmaceutical contracting.
ESSENTIAL RESPONSIBILITIES
Negotiates rates, terms and conditions of pharmacy network contracts in joint partnership with the PBM.
Develops recommendations on pharmacy network market potentials, pricing strategies, and tactics to best capture the value throughout the life of the contract.
Develops preferred network strategies to extract greatest value.
Strategizes and evaluates value of programs such as retail 90 on mail order pricing and penetration rates, negotiations for the development of our preferred, restricted and broad networks for all lines of business, including the new commercial exchange product.
Establishes a consultative relationship with pharmacy management to develop and support effective pharmacy price governance, contract language, pricing requirements and guidelines, and implementation of network communications to Coventry’s membership.
Acts as a liaison with various internal departments and management (i.e., Pharmacy Directors, Actuarial, Legal, PBM) in order to provide both contractual language and guidance on pharmacy network utilization and trends. Delivers comparison financial models for each pharmacy contract to internal customers.
Works closely with Sales, Account Management, and General Managers of our multiple lines of business (Commercial, Medicare, Medicaid) to identify network composition strategies and contracting scenarios.
Provides fiscal analysis and counsel in support of activities to increase formulary compliance and submission of cash based product (i.e., $4 programs) to assist with improved Medicare Star ratings.
Identifies contracting elements that work and determines how Coventry can capitalize on these with other vendors.
Enhances relationships with external contacts in the pharmacy network.
Manages the contracts and negotiates prices for injectables and specialty pharmacy products with specialty pharmacy providers.
Collaborates with the Actuarial department to develop and implement financial models for self-injectable contracting comparisons.
Maintains, monitors, and audits current network rates with the PBM to confirm appropriate reimbursement rates are being applied to each contracted retail pharmacy, and jointly negotiates contracts with the retail pharmacies.
Consults with the retail pharmacies on their ability to implement new formulary decisions or national contracting strategies.
Works with our preferred providers to benchmark and improve performance in various areas of quality.
Qualifications:
JOB SPECIFICATIONS
Bachelor’s degree or equivalent experience. Master’s degree preferred.
Substantial (10-15 years) experience in pharmacy contracting. Substantial knowledge of managed care pharmacy and/or PBM pharmacy networks. Five (5) of more years of PBM operations or related experience.
Advanced general knowledge of databases, spreadsheets and information systems.
Strong analytical, communication, and negotiation skills. Strong problem-solving abilities.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Executive/Senior Level Officials and Managers
Primary Location: , , US
Other Locations: ,
Organization: 10250 - Coventry Prescription Mgt Svcs
Schedule: Full-time
Job Posting: 2013-04-26 00:00:00.0
Job ID: 1311561