Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Provider Relations Manager - Remote
Job Description
The Manager Provider Relations is responsible for leading and managing a Provider Relations department to ensure effective management of employees, departmental interaction, and process improvements. This position is accountable for departmental leadership by optimizing the effectiveness and efficiency of customer service to members, providers and clients. The Manager of Provider Relations works in collaboration with leaders throughout the organization, as well as external stakeholders to ensure resolution to provider and/or client inquires.
Responsibilities
- Manage and support the team through the full cycle contract management processes for Commercial, Medicare Part D, Medicaid, and Health Insurance Marketplace and the provider relations team’s workload to ensure quality outcomes, as well as pharmacy and client satisfaction; may be responsible for provider relations, outreach, or independent pharmacy contract functions
- 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
- Interact, collaborate, and support Prime’s commitments to pharmacy clients by creating a strong interface between contact center operations and provider relations
- 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
- May service as liaison between Prime and pharmacies for applicable legal correspondence, may partner with Prime general counsel as required
- Provide work direction to resolve problems, monitor performance, and provide mentorship, coaching and development for team members to support - department objectives
- Support employee’s participation and success in company recognition programs to improve morale, pharmacy and client service performance and employee retention
- 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
- 1 year of leadership/people management experience
- Must be eligible to work in the United States without 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
Minimum Physical Job Requirements
- Ability to work a flexible schedule including weekends, holidays, and outside of Prime’s core business hours
- Constantly required to sit, use hands to handle or feel talk and hear
- Frequently required to reach with hands and arms
- Occasionally required to stand, walk and stop, kneel and crouch
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Reporting Structure
- Reports to Director Pharmacy Relations and Resolution in the Network Integrity Center of Excellence department
Potential pay for this position ranges from $74,500.00 - $111,700.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our
Benefits Page and click on the "Benefits at a glance" button for more detail.
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, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by 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.
