Manager, Pharmacy Network Administration

Keystone Mercy/AmeriHealth Mercy Family of Companies 

 

PerformRx, is a product of AmeriHealth Mercy, providing Medicaid and Medicare Part D pharmacy benefits management services for members of Medicaid managed care organizations, state Medicaid plans, and Medicare Part D plans. Linking traditional medical management with pharmacy management, PerformRx works to meet financial objectives while improving the quality of health care for Medicaid and Medicare Part D recipients. With more than 20 years of experience serving Medicaid populations, AmeriHealth Mercy and its affiliates comprise the largest family of Medicaid managed care plans in the United States, touching the lives of more than 1.5 million members in eight states. AmeriHealth Mercy/PerformRx is headquartered just outside Philadelphia, near the Philadelphia Airport.

 

Under the direction of the Director, Pharmacy Operations, the Manager of Pharmacy Network Administration is responsible for the overall management of the PerformRx pharmacy network and pharmacy network area.

 

Responsibilities:

?  Coordinates pharmacy contract management: i.e., mailing new contracts, entering executed contracts into the claims processing system and maintaining pharmacy provider files on pharmacy department?s databases. 

?  Monitors and generates status reports on network development activities for assigned projects.

?  Negotiates contracts within a set guideline of rates with existing and new pharmacy relationships as directed by Director.

?  Reviews incoming contracts for any changes made and forwards to Director for approval.

?  Coordinates pharmacy credentialing and maintains pharmacy credentials master database.

?  Creates/ reviews notifications to be sent to all participating pharmacy network providers pertaining to contract changes, new plan notices and new system requirements

?  Assists with contract compliance monitoring through overseeing day-to-day audit operations (internal and external).

?  Coordinates Pharmacy Network audits through outside vendor.

?  Analyzes audit report findings and provides variance reports on pharmacies that fall outside of billing and dispensing practices standards.

?  Assist in the testing of audit procedures and recommends changes.

?  Researches, resolves and responds to provider audit disputes when audit issues or concerns as raised by pharmacy provider.

 

Requirements:

? Bachelor?s Degree (MBA a plus) with focus in finance and some technical knowledge or equivalent experience in the healthcare field.

?  Experience in pharmacy or some PBM industry preferred. 

?  At least 2-3 years professional experience in management required.

 

We offer a competitive salary and many benefits, including medical/dental, basic/supplemental life insurance, STD/LTD, 401K, pension plan, tuition reimbursement, vacation, no city wage tax (non-Philadelphia resident) and free parking.

 

Qualified candidates please send resume to: humanresources@kmhp.com or fax to (215) 937-5363. EOE.