Pharmacy Benefits Network Management SME

Terms of Employment:
W2 Contract-to-Hire, 12 Months
This position is remote. Candidates must reside in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas.

Overview:
Join a leading managed care organization and take charge of our pharmacy network operations. In this crucial role, you will oversee our relationships with various pharmacy network partners (retail, mail, specialty) to ensure they meet contractual, regulatory, and service-level standards. This is a non-technical, operational management position focused on performance, compliance, and optimization. You will
Manage the performance of pharmacy network partners, monitoring key metrics like claims volume, network adequacy, and SLAs.
Oversee and support provider network processes including credentialing, re-contracting, and terminations.
Use performance data to identify trends, address concerns, and drive operational improvements in network access and efficiency.
Collaborate with internal business, operations, and regulatory teams to ensure network operations are aligned with enterprise goals.

Required Qualifications:
Experience in pharmacy network management from a managed care/payer perspective.
Strong knowledge of pharmacy network types, including retail, mail, and specialty.
Proven experience managing vendor/provider performance against contracts and SLAs.
Ability to use data to analyze network performance and drive decision-making.

Preferred Qualifications:
Experience with provider credentialing and re-contracting processes.
Bachelor's degree in a related field.