McKesson requires new employees to be fully vaccinated for COVID-19 as defined by the CDC, subject to applicable, verified accommodation requests.
CoverMyMeds, part of McKesson Corporation, is a fast-growing healthcare technology company that has been recognized as a "Best Place to Work" by Glassdoor and a "Best Company to Work For" by FORTUNE. Through innovation and collaboration, CoverMyMeds' solutions help people get the medicine they need to live healthier lives by seamlessly connecting the healthcare network to improve medication access; thereby increasing speed to therapy and reducing prescription abandonment. CoverMyMeds' network includes 75 percent of electronic health record systems (EHRs), 50,000+ pharmacies, 750,000 providers and most health plans and PBMs.
The Pharmacy Network Contract Manager is responsible for providing support related to the pharmacy network contracting functions of the company collaborating and coordinating with the teams supporting discount programs and related products and solutions requiring a participating pharmacy network. The position is responsible for developing and maintaining relationships with pharmacy service providers, including performing and/or assisting with negotiating service contracts, resolving issues and appeals associated with participating pharmacy network contracts.
Provide sales support for contract negotiations with Chain, PSAO, and Independent pharmacy network providers for products and associated product lines of business and acts as the liaison regarding product / pricing modifications and on-going negotiations.
Works with pricing, data scientist, product mgt, and external partner to capture, implement, and maintain network guarantee requirements (Generic Effective Rates, Brand Effective Rate, Specialty Effective Rate, Administration Fee Effective Rate), and reviews and provides final provider guarantee reconciliations and analyses to achieve overall network and client financial obligations.
If required, credential providers for participation in products and associated product lines of business pharmacy networks
Be the subject matter expert on standard pharmacy services agreement language including compliance and performance measures
Maintain a detailed level of understanding of participating pharmacy network products and services
Understand the complex relationships between various pharmacy types, e.g. Chains, Independents, Health Systems, etc., their lines of business, and how those affect the demographics of the participating pharmacy network
Manage the implementation of contract language and reimbursement terms into adjudication platform including assessing new customer/partner requirements in conjunction with the adjudication architect.
Administration and Compliance
Effectively identifies pharmacy network setups and configuration issues to claims processing, proposing sustainable solutions or immediate resolutions.
Provides support in tracking and maintain pharmacy network rate information.
Fully understand the various aspects of a prescription claim.
Working cross departmentally, establish and maintain standard operating procedures and policies to manage and resolve contract and price appeals with participating pharmacies.
Working cross departmentally, create and publish policies and procedures regarding pharmacy provider network contracting
Properly store contract documentation
Develop a thorough understanding of the network structure of products and associated channel partners and reseller clients
Support coordinate with Account Managers handling client inquiries and requirements for any pharmacy provider network functions
Initiates and assists coordination with internal teams, such as IT, Operations, etc. in order to improve efficiency, accuracy, and capacity of network adjudication platform functionality to manage the network.
Develops training material and supervises training of new network administration staff to achieve a steep learning curve and enable high contribution in short period of time.
Maintains and monitors team's performance as it relates to the administration and operational duties of the department.
Supports and manages contract activities including but not limited to; the generating of contracts and amendments, facilitates legal and executive review and approach of all contract terms and conditions. Monitors contractual obligations, GERs, & SLAs. Review internal GER reports prior to external distribution.
Serves as SME of Pharmacy Network operations in order to properly support other departments, particularly Product Management Network relations, Client services, IT, Finance, Sales, and Network development.
Oversees resolution of intricate pharmacy provider issues and complaints, and price appeals. Research problems and collaborates with internal/external partners to resolve escalated issues.
Establish, negotiate and maintain relationship and contracts with 3rd party vendors for services like wrap-around networks and pricing for product and associated product lines.
Develop effective, ongoing relationships with pharmacy network providers and external partners.
Ensure accuracy of pharmacy provider information and communicate to all appropriate channels
Maintain professional levels of communication with network providers while monitoring and responding to all external requests
Research pharmacy provider network activity in the marketplace and provide updates to Client Services and upper management.
Monitor legislation changes affecting PBM industry related to Pharmacy Network compliance.
Maintain active participation in NCPDP work groups and other organizations to understand changes or updates in prescription claim processing standards
Attend industry conferences, trade shows, and meetings (e.g., NCPDP) as necessary for continuing education
Typically requires 7+ years relevant experience in contracts, legal, and compliance
3-6 years of experience in negotiating contracts for reimbursement within the pharmacy industry
Solid understanding of pharmacy dispensing industry and pharmacy claim acumen
Experience leading cross-functional team as well as an ability to operate effectively and efficiently on complex, fast-paced projects.
Ability to drive results with positives outcomes through project management within established deadlines.
Very strong attention to detail and ensures thorough execution of all aspects of assigned tasks and responsibilities.
Excellent problem solving, decision-making, and analytical expertise.
Excellent Microsoft Office skills, including Outlook, Teams, Excel, and Word
Degree or equivalent. Bachelor's degree in a related field (health administration, business, finance) preferred.
General office environment
McKesson is an Equal Opportunity/Affirmative Action employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.Qualified applicants will not be disqualified from consideration for employment based upon criminal history.
McKesson is committed to being an Equal Employment Opportunity Employer and offers opportunities to all job seekers including job seekers with disabilities. If you need a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] . Resumes or CVs submitted to this email box will not be accepted.
Current employees must apply through the internal career site.
We deliver careers with purpose and potential. Our focus on better health starts with creating an inclusive environment with strong values where you can build a fulfilling career. You can count on us to provide you with resources and opportunities to grow and be your best, while contributing to our pursuit of improving lives. Every day, McKesson’s employees deliver products to healthcare providers that make a difference in the care and life of a patient. We work to distribute medical supplies, bandages, syringes, vials of flu vaccine, and pharmaceutical drugs to help real patients like Jack, an eight-year-old boy battling cancer. We take that job seriously. Together, the work we do is shaping the future of healthcare. If you are passionate about combining a meaningful career with a balanced life, join us on this journey and apply for a job with McKesson today. Every day, McKesson’s employees deliver products to healthcare providers that make a difference in the care and life of a patient.