Program Manager-Pharmacy Contracting

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Job Summary:

Key Position Details:

• 1.0 FTE (80 hours per two-week pay period)
• 8-hour day shift
• No weekends

Job Description:

Oversees proper payer contracting, payer relations, and revenue management for health system pharmacy. Ensures contracting requirements are met and provides analysis, problem resolution, auditing, reporting, process recommendations, and training for optimal business outcomes. Acts as the pharmacy and payer point of contact for related problems/questions. Responsible for in-house financial audits and preliminary analysis including payer performance, contract compliance, and business analysis. Disseminates contract reimbursement information to providers and relevant stakeholders and serves as a key strategic partner with the payer relations and contracting department.

Principle Responsibilities

• Strategy and Execution
  • Develops, implements, and manages a comprehensive, market-based payer strategy to ensure pharmacy network participation and optimization.
  • Ensures the alignment of payer programs with the health system's strategic business initiatives with close alignment to associated stakeholders, i.e., network integrity team.
  • Monitors and assesses network requirements, ensuring compliance with payer standards, credentialing and performance metrics.
  • Supports contract negotiations with commercial insurers, Medicare/Medicaid, and PBMs to optimize network access and reimbursement.
• Account Management and Payer Relations
  • Establishes relationships with key payer stakeholders, ensuring strong partnerships that drive retention and access with a focus on pharmacy.
  • Conducts regular business reviews with payers to assess performance, contract adherence, and strategic opportunities.
  • Provides subject matter expertise within the credentialing and re-credentialing process for payer contracts and payer network participation.
  • Evaluates and responds to Requests for Proposals (RFPs) and Requests for Information (RFIs) to secure new payer partnerships.
  • Advocates for fair access to pharmacy networks by engaging in payer discussions, policy reviews, and appeals processes.
  • Tracks payer policies and formulary changes, assessing their impact on pharmacy services and patient access.
  • Serves as a point of contact for payer-related escalations, resolving access barriers and reimbursement disputes.
• Analytics
  • Utilizes data to support strategic decision-making, network expansion, and network maintenance.
  • Provides data-driven insights to payers and internal stakeholders.
  • Communicates pharmacy's value proposition and identify areas for data alignment.
  • Collaborates with revenue cycle and billing teams to analyze and optimize reimbursement and address payer-related issues.
• Other duties as assigned.

Required Qualifications

• Bachelor's degree in Business, finance or related area
• 5+ years in pharmacy contracting, payer relations, pharmacy network management, or healthcare reimbursement

Preferred Qualifications

• Master's degree in Business, finance or related area
• 2+ years leadership experience in pharmacy-related contracting, or infusion, specialty, or retail pharmacy

Licenses/Certifications

• Registered Pharmacy Technician - MN Board of Pharmacy required upon hire preferred

Physical Demands

• Light Work:
• Lifting weight up to 20 lbs. occasionally, up to 10 lbs. frequently

Pay Range

Benefit Summary

Allina Health believes the best way to provide safe and compassionate care for our patients is by nurturing the passion of those who care for them. That's why we devote extraordinary resources to help you grow and thrive - not only as a professional but also as a whole person. When you join our team, you have access to a wealth of valuable employee benefits that support the total well-being - mind, body, spirit and community - of you and your family members.

Allina Health is all in on your well-being. Because well-being means something different to everyone, our award-winning program provides you with the resources you need to help you navigate your personal journey. This includes well-being dollars, dedicated well-being navigators, and many programs, activities, articles, videos, personal coaching and tools to support you on your journey.

In addition, Allina Health offers employee resources groups (ERGs) -- voluntary, employee-led groups that serve as a resource for members and organizations by fostering a diverse, inclusive workplace aligned with the organization's mission, values, goals, business practices, and objectives. Allina Health also engages employees in various community involvement and volunteering events.

Benefits include:

• Medical/Dental

• PTO/Time Away

• Retirement Savings Plans

• Life Insurance

• Short-term/Long-term Disability

• Voluntary Benefits (vision, legal, critical illness)

• Tuition Reimbursement or Continuing Medical Education as applicable

• Student Loan Support Benefits to navigate the Federal Public Service Loan Forgiveness Program

• Allina Health is a 501(c)(3) eligible employer

*Benefit eligibility/offerings are determined by FTE and if you are represented by a union.