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Pharmacy Network Contracting Director

Company: DST Systems, Inc.
Location: Kansas City
Posted on: February 22, 2021

Job Description:

The speed of technology. The influx of data. Shifting regulations. Increased customer expectations.That's where you'll find SS&C, helping clients find opportunity in ever-changing and complex customer, business, and regulatory requirements. Mastering complexity is a constantly changing and evolving challenge - one that only a few people can embrace and thrive upon.If you see your opportunity in complexity , then we are the right fit for you.Job Description:---Organizational OverviewAs an Associate with SS&C Health, you will be part of an organization that promotes better health outcomes for consumers through clinical and technological innovations. We accomplish this by leveraging the robust technology foundation and powerful analytic resources that are the core of SS&C, with industry leading clinical expertise and strategic pharmacy and healthcare solutions. You will join a team that is redefining the value of pharmacy in healthcare through the integration of advanced analytics, clinical insights and transformative digital capabilities.Role OverviewDevelops and manages SS&C pharmacy networks. Develops and manages pharmacy networks including those for retail, mail and specialty as well as custom networks as needed within the pharmacy network claims adjudication system. Manages the development and implementation of statewide provider development/ communications activities. Establishes contract negotiation priorities to support a stable and competitive network of pharmacies nationwide. Negotiates contract terms with assigned pharmacy chains and coordinates with internal stakeholders to ensure offered terms are acceptable. Works with network analytics teams on evaluating pharmacy and customer performance. Works with network analytics team and pharmacy operations director on establishing strategy and roadmap for pharmacy and customer performance. The director will support network underwriting initiatives on both potential contract reimbursement changes, as well as bids for new businessResponsibilities

  • Develops and manages pharmacy networks including those for retail, mail and specialty as well as custom networks as needed within the pharmacy network claims adjudication system.
  • Establish and maintain relationships with pharmacy chains and PSAOs, as well as national pharmacy organizations, i.e. NCPDP.
  • Cultivates effective relationships with pharmacy provider representatives, client representatives and internal stakeholders, including adherence to agreed-upon rules of engagement and roles & responsibilities.
  • Establishes contract negotiation priorities to support a stable and competitive network of pharmacies nationwide
  • Negotiates contract terms with assigned pharmacy chains and coordinates with internal stakeholders to ensure offered terms are acceptable
  • Works with network analytics teams on evaluating pharmacy and customer performance
  • Works with network analytics team on establishing strategy and roadmap for pharmacy and customer performance
  • Collaborates with the Sales organization to execute company growth initiatives through the acquisition of new networks, providers, and vendors.
  • Work with applicable teams including IT and Product for enhancements to the pharmacy network claims adjudication system.
  • Provide other assistance as needed to the pharmacy networks team and other departments including the Implementation team.
  • Adheres to strict procedural and regulatory compliance quality standards, including thorough and accurate documentation, testing protocols, and claims analysis.
  • Sets high standard and encourages new ideas for improving organizational performance
  • Utilizes planning, prioritizing, and organizational skills to ensure timely deliverables, high levels of quality, and efficient use of resources
  • Maintains commitment to operational goals in the face of obstacles
  • Collaborates and cultivates positive relationships with internal and external customers through delivery of sustainable, measurable, accurate, reliable, and timely results that meet or exceed customer expectations
  • Manages processes to achieve service commitments, including sustainable, measurable, accurate and timely execution of project deliverables
  • Promptly responds to service failures, resolves issues, and escalates concerns as appropriate
  • Promotes continuous improvement by ensuring adherence to quality principles
  • Seeks out and actively participates in business initiatives that contribute to service excellence
  • Work with Legal teams on creating and revising pharmacy contracting documents
  • Based upon career path level, completes special projects and assignments (such as such as leading workgroups, overseeing projects, mentoring team members, etc.)
  • Support network underwriting initiatives on both potential contract reimbursement changes, as well as bids for new business;
  • Support the overall growth of SS&C business by functioning as the subject-matter expert (SME) in the RFP process, the new business implementation process and all auditing processes
  • Ensure network management controls comply with contract requirements, SSAE 16 SOC 1 control objectives, URAC accreditation standards and any other prevailing standards for audit or accreditation
  • Provide escalation and resolution of any and all Network related issues
  • Support the Director of Pharmacy Operations in all network related deliverables
  • Hold direct reports accountable for meeting performance standards and departmental performance goals; mentors staff; measures staff performance and completes regular performance reviews and rankings.
  • Create and maintain a quality assurance culture within the department in all work processes and outcomes
  • Works across the organization, with clinical and administrative areas, to develop and deploy provider systems, standards, policies and procedures to improve network performance.
    • Qualifications
    • Bachelor's degree and 8 years of work-related experience, or Master's degree and 6 years of work-related experience, or 10 years equivalent work-related experience
    • Ability to understand and/or have experience with NCPDP standards and requirements.
    • Proven track record of developing, maintaining and testing claims adjudication systems or pharmacy networks.
    • Experience in a Provider Relations, Chain Pharmacy, PSAO, Client Service, or a Relationship Management role.
    • Strong communication skills with the ability to develop effective working relationships with internal and external stakeholdersLocation:Kansas City Missouri SS&C is an equal opportunity employer and values a diverse and inclusive workplace. All qualified candidates will receive consideration for employment without regard to age, race, color, religion, genetic information, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. --For more information about Equal Opportunity in the Workplace please click here-- and here . SS&C is committed to working with and providing reasonable accommodation to job applicants with disabilities. If you are a qualified individual with a disability and need an accommodation or accessibility assistance to complete the online application, please contact us at PeopleCenter@dstsystems.com for assistance. Posted 8 Days Ago Full time R250313 About Us SS&C is a global provider of investment and financial services and software for the financial services and healthcare industries. Named to Fortune 1000 list as top U.S. company based on revenue, SS&C is headquartered in Windsor, Connecticut and has 20,000+ employees in over 90 offices in 35 countries. Some 18,000 financial services and healthcare organizations, from the world's largest institutions to local firms, manage and account for their investments using SS&C's products and services.

Keywords: DST Systems, Inc., Kansas City , Pharmacy Network Contracting Director, Executive , Kansas City, Kansas

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