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Manager, Provider Networks

Denver, Colorado, United States; New York, New York, United States

Location: Hybrid (Local to NYC or Denver Metropolitan areas)

Position Responsibilities: 

  • Oversee day-to-day operations of the Provider Relations Network team responsible for ongoing setup and maintenance of standard and custom pharmacy networks that support all Capital Rx clients.   
  • Provide guidance, follow up and resolution to internal teams regarding network related inquires and concerns by serving as subject matter expert for the Provider Relations Network team. 
  • Provide guidance and support to members of the Provider Relations team regarding the pharmacy claims adjudication platform, based on knowledge and expertise of  NCPDP standards and processes when needed. 
  • Develop, manage, and monitor pharmacy networks including those for retail, mail and specialty as well as custom and in-house pharmacy networks to ensure networks are processing appropriately within the pharmacy network claims adjudication system. 
  • Perform extensive and routine network testing based on network setup, reconfigurations, as well as development changes and upgrades to ensure pharmacy claims are adjudicating and pricing accurately within the pharmacy claims adjudication platform. 
  • Collaborate with internal teams when implementing and reconfiguring networks based on requirement gathering sessions and documented ADHOC network change requests to ensure network configurations satisfy the intent and expectation of the clients.  
  • Serve as a liaison to the applicable Development and Product teams to assist with implementation and development of needed enhancements and system bug fixes within the pharmacy network claims adjudication system.  
  • Provide cross functional support to the Provider Relations and all other internal Capital Rx teams when Network support is needed and applicable.  
  • Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance. 

 

Preferred Qualifications: 

  • Management level (or higher) experience in pharmacy claims adjudication, HealthCare, or Prescription Benefit Management positions. 
  • Experience managing a team and direct reports.  
  • Project management knowledge and experience. 

 

Qualifications / Profile: 

  • Bachelor’s degree or equivalent relevant experience. 
  • 5+ yrs of PBM experience in provider/network relations, pharmacy network development or claims processing system development, or other relevant experience. 
  • Sufficient knowledge of NCPDP standards and requirements. 
  • Strong performance history that identify comprehensible skills needed to develop, maintain and test pharmacy claims adjudication systems or pharmacy networks. 
  • Strong communication skills with the ability to develop effective working relationships with internal and external stakeholders. 
  • Ability to work independently in a fast-paced environment to meet required deadlines  

 

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. 

Salary Range

$75,000 - $90,000 USD

About Capital Rx 

Capital Rx is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, Capital Rx is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native enterprise health platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. 

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