Responsibilities:

• Lead PerformRx Network Management efforts to support a stable and competitive network of pharmacies nationwide
• Ensure pharmacy network meets client needs contractually and verify regularly that claims adjudication rates match contractual agreements
• Manage the daily activities of the Network Operations team including staffing models, workflow management and audit support duties
• Manage long and short term projects
• Develop, implement and maintain Process Improvement and Quality Improvement plans
• Support the overall growth of PerformRx business by functioning as the subject-matter expert (SME) in the RFP process, the new business implementation process and all auditing processes
• Ensure Network management controls comply with contract requirements, SSAE 16 SOC 1 control objectives, URAC accreditation standards and any other prevailing standards for audit or accreditation
• Provide escalation and resolution of any and all Network related issues
• Support the Director of Pharmacy Operations in all network related deliverables
• Encourage the growth of all direct and indirect reports through skills development, objectives and goal setting.
• Hold direct reports accountable for meeting performance standards and departmental performance goals; mentors staff; measures staff performance and completes regular performance reviews and rankings.
• Create and maintain a quality assurance culture within the department in all work processes and outcomes

Education/Experience:

• Bachelor’s degree required, preferably in managed care or business field
• Master’s degree preferred
• National Pharmacy Technician Certification (i.e., ExCPT, NCCT, PTCB) preferred
• Project management experience preferred
• Minimum of five (5) years of provider contract/reimbursement experience in a PBM setting required
• Minimum of three (3) years of supervisory/management/leadership experience required, preferably in a PBM setting
• Minimum of three (3) years contract and negotiating contracts experience required
• Current/recent experience and/or working knowledge of federal, state and local regulations that pertain to credentialing, contracting, PBM programs and pricing
• Must have a general understanding of the PBM business environment and associated systems
• Strong verbal and written communications skills to interact with the client directly