Dir Pharmacy Provider Network- Long Term Care, Home Infusion & Specialty

Health Net, Inc. (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies.  Health Net’s mission is to help people be healthy, secure and comfortable.  The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals.  For more information on Health Net, Inc., please visit the company’s Web site at www.healthnet.com

 

JOB SUMMARY:
This position oversees and directs the strategic development and maintenance of the nationwide network of pharmacy providers. Ensures adequate contracted networks are in place to deliver Health Net’s pharmacy benefits. Negotiates rates, financial agreements, and establishes special programs with providers. Supports and contributes to the overall vision and direction of Health Net.

 

ESSENTIAL DUTIES AND RESPONSIBILITES: Oversees continuous provider network development and expansion to support the organization’s current and future products. Responsible and held accountable to ensure that pharmacy provider database are maintained current and accurate, and information is presented internally and externally in a timely and professional manner. Negotiates complex network agreements. Oversees and directs all provider contracting efforts to ensure the achievement of corporate growth and cost objectives. Monitors geographic distribution of pharmacy network to ensure adequate access for Health Net members. Within accepted Health Net practices, has authority to finalize and close contract negotiations. Develops and implements provider network strategies that support and contribute to the overall mission of Health Net. Leverages network relationships to develop strategic partnering programs with selected national and/or regional network providers to: Develop and execute formulary compliance, utilization and/or cost management programs, as appropriate to our members (encourage appropriate use of generics). Promote Health Net’s brand identity.Establishes and maintains superior provider relations through the development of effective and efficient communication and outreach programs, including development and distribution of network communication materials. Monitors compliance (Health Net and provider) to contract requirements. Takes the appropriate action to ensure compliance with company policies and governmental regulations. Responsible for accurate analyses and assessments of quality of care and access by patients. Supports Sales and Marketing efforts through network development and negotiations of acceptable rates. Formulates and executes policies and procedures for network contracting and operations. Ensures that Pharmacy network staff is adequately trained in all skills necessary and appropriate to their job, including but not limited to the following areas: contract negotiation and/or interpretation and clarification, marketing programs, Health Net products, customer service, provider network management and project management. Other areas include:
o Develops and maintains national and regional pharmacy provider contract templates.
o Monitors relevant legislative, regulatory and industry developments and standards; ensures compliance with the same.
o Develops and implements pharmacy credentialing programs, or other vehicles, to enhance safety and quality monitoring programs to ensure safe and effective network delivery of the pharmacy benefit.
o Pharmacy provider directory management
o Develops, implements, and manages infra-structure necessary to execute and support Specialty fulfillment strategies.
o Develops and implements specialty MAC pricing program.
o Actively participates with, and liaisons between, Health Net and Pharmacy trade organizations (NACDS, NCPA, LTCPA, NHIA, NCPDP), as appropriate.



REQUIREMENTS:


Education:
Bachelor of Science Degree required; Master’s preferred

 

Certification/License:
Licensed pharmacist preferred

 

Experience:Minimum five years experience in the managed care, PBM, or other relevant pharmacy provider network related industry, including minimum two years experience in a management role Direct and relevant pharmacy contracting experience, including negotiating rates

Knowledge, Skills & Abilities:Excellent professional presentation abilities and experience Oral and written communication skills required Ability to professionally represent and negotiate complex pharmacy provider contracts (regional and national); Knowledge of principles and techniques of negotiating, and demonstrated skills in leading negotiations to a close; Strong analytical, problem solving and project management skills Demonstrated cooperative and professional attitude with internal and external contacts Communication skills and experience developing, analyzing, applying, interpreting and communicating policies, procedures and regulations Financial and business knowledge and skills to analyze and interpret complex utilization and financial data Ability to travel (limited)

 OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

 

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
 
Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer M/F/V/D.