What are the responsibilities and job description for the Provider Contracting Manager position at ProCare Rx?
ESSENTIAL DUTIES AND RESPONSIBLITIES include but are not limited to the following:
● Responsible for day-to-day operational support for pharmacy questions via phone and/or email.
● Responsible for Network Development emails; respond to requests and questions from pharmacies in a timely
manner.
● Initiate and tracks contract from initial draft to full execution.
● Provide written and/or verbal contractual education for pharmacies as needed.
● Target and recruit additional pharmacies to meet Plan network adequacy requirements and/or requests and
maintain network relationships with small independent/chain pharmacies.
● Participate in re-contracting efforts as required and directed.
● Shepherd contracts through the negotiation process for independent pharmacies and small chains and maintain
relationships with those contracted entities.
● Lead Hospice Contracting initiatives.
● Update multiple systems with contract data and demographic information, as required.
● Submit pricing changes to the Quality Assurance team.
● Assist in RFP responses.
● Responsible for maintaining the Pharmacy Administrative Manual, (PAM).
● Work with the Credentialing Specialist to ensure credentialing standards are met.
● Investigate pharmacy claim issues; pricing complaints and perform Pricing Escalation triage for the network
Analyst.
● Communicate with the MAC/Reimbursement team as required.
● Participate in the weekly GER review call and make changes in the system based on those reviews.
● Attend meetings for new plan implementations.
● Ensure deliverables are on time and meet quality levels as expected by ProCare’s internal and external customers.
● Coordinate and follow up on pharmacy network fax/email blasts as required.
● Responsible for oversight of monthly import reports and weekly cascading of data through various systems.
● Prepare documentation for audits, as requested by manager and support URAC accreditation.
QUALIFICATIONS AND REQUIREMENTS
● Must be a strong team player who can adapt to a team environment and work independently in a fast-paced
environment.
● Must be able to work in multiple computer systems simultaneously on a daily basis.
● Excellent telephone etiquette and verbal/written communication skills.
● Must be highly organized, motivated, take initiative and possess a willingness to learn new processes.
● Extreme attention to detail required.
● Working knowledge of computers and related software applications such as Word, Excel, Adobe and Outlook a
must.
● Must be able to review contracts and learn the differences of each contract.
EDUCATION AND EXPERIENCE
Associate’s Degree with two years of experience in a health care setting working with contracts and/or provider
relations preferred. PBM experience a plus.
PHYSICAN DEMANDS
Requires sitting, standing, and occasional light lifting.
Please note while this job description is a comprehensive overview, additional responsibilities may be part of the role.
ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please email us at HR@procarerx.com.
ProCare Rx is an Equal Opportunity Employer.
