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Title
Text copied to clipboard!Pharmacy Network Specialist
Description
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We are looking for a Pharmacy Network Specialist to join our healthcare team and support the development, maintenance, and optimization of our pharmacy provider network. This role is essential in ensuring that our members have access to a high-quality, cost-effective pharmacy network. The ideal candidate will have a strong understanding of pharmacy operations, provider contracting, and healthcare regulations.
As a Pharmacy Network Specialist, you will be responsible for building and maintaining relationships with pharmacy providers, negotiating contracts, and ensuring compliance with regulatory and accreditation standards. You will work closely with internal departments such as compliance, legal, and provider relations to ensure the network meets organizational goals and member needs.
You will also analyze pharmacy network performance, identify gaps in coverage, and implement strategies to improve access and efficiency. This includes monitoring provider performance, resolving issues related to claims or service delivery, and supporting audits and reporting requirements. Your role will be critical in ensuring that our pharmacy network operates smoothly and delivers value to both the organization and its members.
The successful candidate will possess excellent communication and negotiation skills, a detail-oriented mindset, and the ability to manage multiple projects simultaneously. Experience in managed care, pharmacy benefit management (PBM), or healthcare network development is highly desirable. A background in pharmacy or healthcare administration is also beneficial.
This position offers the opportunity to make a meaningful impact on patient care and access to medications. If you are passionate about healthcare and have the skills to manage complex provider networks, we encourage you to apply.
Responsibilities
Text copied to clipboard!- Develop and maintain relationships with pharmacy providers
- Negotiate and manage pharmacy network contracts
- Ensure compliance with regulatory and accreditation standards
- Monitor pharmacy network performance and identify improvement areas
- Resolve provider issues related to claims and service delivery
- Support audits and prepare required reports
- Collaborate with internal departments to align network strategies
- Analyze network adequacy and implement access solutions
- Maintain accurate provider data and documentation
- Assist in credentialing and re-credentialing processes
Requirements
Text copied to clipboard!- Bachelor’s degree in pharmacy, healthcare administration, or related field
- 3+ years of experience in pharmacy network management or PBM
- Strong knowledge of healthcare regulations and pharmacy operations
- Excellent negotiation and communication skills
- Ability to analyze data and generate actionable insights
- Proficiency in Microsoft Office and network management tools
- Detail-oriented with strong organizational skills
- Ability to manage multiple projects and meet deadlines
- Experience with provider contracting and credentialing
- Understanding of managed care principles
Potential interview questions
Text copied to clipboard!- Do you have experience managing a pharmacy provider network?
- What strategies have you used to improve network performance?
- How do you ensure compliance with healthcare regulations?
- Describe a time you resolved a provider issue successfully.
- What tools do you use to analyze network adequacy?
- How do you stay updated on changes in pharmacy regulations?
- Have you worked with PBMs or managed care organizations?
- What is your approach to negotiating provider contracts?
- How do you handle multiple priorities and deadlines?
- What role do you think pharmacy networks play in patient care?
