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Network Contract and Compliance Manager GSA

Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.

Pharmacy Network Contract and Compliance Manager - GSA Overview of Position

The Pharmacy Network Contract Manager is responsible for the strategic development of the pharmacy network services and solutions for retail, mail, and specialty providers. This role is the primary SME on contracting with pharmacy providers to meet strategic provider network objectives. This position is responsible for monitoring the terms of all provider contracts and ensuring compliance with all terms, including all financial and operational terms.

The Pharmacy Network Contract Manager is a key subject matter expert on pharmacy network strategy and is the key liaison with all internal and external clients on pharmacy provider issues. The Pharmacy Network Contract Manager is expected to work collaboratively with the Network Oversight teams on pharmacy performance activities, ensuring compliance with audit and contract payment terms. This position requires prioritizing multiple tasks in a fast-paced environment.

Provides leadership and support to the Provider Relations/Network Management team members. This role represents the pharmacy network internally and coordinates with other functions to implement network changes, complete projects, address ongoing service needs as well as identify and implement operational enhancements. The Pharmacy Network Contract Manager is also responsible for GSA contract negotiation, implementation, and compliance.

Location: Remote/Telecommuter role with 25% overnight travel

What will be my duties and responsibilities in this job?

• Implements defined contract strategy, negotiates contracts, in collaboration with legal and finance, to meet network objectives for both Change Healthcare and client custom requests

• Monitors and ensures compliance to all provider contract terms and deliverables

• GSA contract Compliance

• GSA contract Implementation

• GSA contract negotiations

• Knowledge and resource expert regarding complex provider issues and able to resolve to achieve positive outcome

• Supports internal teams with network solutions across all channels to meet client and organizational objectives

• Establish, monitor, and achieve client and organizational network access goals

• Provide recommendation on Network activity based on utilization trends and pharmacy service results

• Promote continual improvement in network oversight areas, including credentialing, audits and FWA and other compliance monitoring needed to ensure contract compliance

• Develops and manages weekly, monthly, and quarterly network reports

• Serves as a mentor to other Network Management staff and resources within the organization

• Works on special projects

• Individual will develop new approach to solve compliance monitoring and contract negotiation strategies as well as enhance existing processes. Including both PBM and GSA contract monitoring

• Develop new monitoring tools for multiple contracts across multiple lines of business. This position will be responsible for developing and implementing best practices for all contract compliance monitoring

• This role will have strong requirements for decision making directly for contract compliance direction and guidance as well as negotiating decisions on contract rates and terms within specified parameters. Decisions applicable to GSA (government) recommendations to legal and compliance teams

What are the requirements needed for this position?

• 3+ years of experience in the Pharmacy Benefits Management industry, focused on network management. Other experience in managed care industry will be considered

• 3+ years GSA contract negotiation, implementation, and compliance experience

• Knowledge and hands-on experience with federal government contracting methods and applicable procurement laws and regulations, including but not limited to FAR and GSAR.

• Working knowledge of GSA schedules and contracts

• In-depth knowledge and execution of GSA schedules’ compliance requirements

• Experience negotiating multi-year agreements w/federal contracting officers

• Strong understanding of PBM or Managed Care Industry

• Bachelor’s Degree in Business or Healthcare Administration or 5+ years of relevant work experience in lieu of a degree

• Strong understanding of Contract Compliance

• Proficiency building relationships and negotiating with healthcare providers

• Ability to independently and effectively communicate both internally and externally

• Federal Supply Schedule compliance and audit experience

• Knowledge of provider and payor roles, responsibilities and challenges, an understanding of healthcare financing, access issues, delivery systems and quality controls

• Proficiency with Microsoft office applications

• Excellent verbal and written communication skills – including ability to interpret and communicate regulatory guidance

• Impeccable attention to detail

• Results oriented and process driven

• Ability to successfully work in virtual setting

• Ability to successfully work in virtual setting, including effective collaboration with diverse stakeholders, including, business-focused teams, legal and compliance teams, and finance and accounting teams

What are the working conditions and physical requirements of this job?

General office demands

How much should I expect to travel?

This position may require up to 25% overnight travel. Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

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Diversity and Inclusion:

•At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.•Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity Feeling Inspired? Ready to #MakeAChange? Apply today!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and, when j ob-related and consistent with business necessity , we may require periodic testing for certain roles. Some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.