Provider Relations Manager - Remote

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

The Manager of Provider Relations plays a critical leadership role in developing, managing, and maintaining strong internal and external relationships. The role is responsible for overseeing pharmacy outreach, independent pharmacy contracting, compliance and issue resolution with pharmacies to ensure network integrity, service quality, and cost-effectiveness. The role is also responsible for leading and managing a Provider Relations team to ensure effective performance management of employees, departmental interaction, and process improvements.

Responsibilities

• Manage and mentor a team to achieve team and company goals, monitor performance and provide coaching and development opportunities
• Manage team through independent pharmacy contract processes for retail networks; serve as the primary point of contact for key pharmacy providers, including pharmacy outreach and strategic partners to ensure quality outcomes; includes oversight where pharmacy termination from pharmacy networks may occur
• Oversee and approve new key processes the team develops as part of continuous improvement and develop strategies to achieve world class status in operational effectiveness and pharmacy and client experience while ensuring compliance and adherence to all regulatory guidelines
• Serve as liaison between Prime and pharmacies by supporting legal correspondence, addressing escalated provider concerns and disputes, and strengthening the interface between contact center operations and provider relations through effective pharmacy communications
• Develop and maintain relationships with internal and external stakeholders regarding the management and development of Network Management strategies; actively oversee and support Peak Season activities, including pharmacy outreach and pharmacy communications
• Other duties as assigned

Minimum Qualifications

• Bachelor's degree in healthcare, business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
• 6 years of work experience in customer service or contracting experience within healthcare, PBM or highly regulated industry
• 2 years of leadership/people management experience

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Ability to learn complex IT systems, both internal and web based and be able to train others to use systems and maintain best practices and quick reference guides
• Above average knowledge of Microsoft Office Suite of products, including Excel and PowerPoint
• Demonstrated business written and oral communication skills
• Demonstrated ability to establish and rapport and build relationships at all levels within an organization
• Strong attention to detail, follow through and root cause analysis of issues
• Excellent organizational, time management, problem solving and analytical skills

Preferred Qualifications

• Previous experience in pharmacy network management, legal or compliance
• Previous project management skills
• Previous experience with RxClaim
• Previous call center experience
• Certified Pharmacy Technician (CPhT)
• Previous work experience in the PBM or Healthcare Industry
• Previous experience leading a team in a call center environment

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.