Pharmacy Network Relations & Contracting Specialist - REMOTE
Role and ResponsibilitiesThe Pharmacy Network Relations and Contracting Specialist is responsible for managing relationships with assigned pharmacy organizations, including regular communication, contract and reimbursement negotiations, and day-to-day service interactions with Liviniti. This role designs and implements strategies to build and maintain high-performing, compliant, and cost-effective pharmacy networks that align with Liviniti's fully transparent, 100% pass-through PBM model. Responsibilities also include partnering with Pharmacy Network Operations and other internal teams to ensure contract terms are accurately reflected in Liviniti systems and that claims are adjudicated correctly. Additional responsibilities may include representing the network relationship with external Liviniti clients and customers and serving as a subject matter expert for specific network product offerings. The Pharmacy Network Relations and Contracting Specialist is required to perform, but not limited to, the following duties and undertake the following responsibilities professionally:
Create, establish, build, and retain strong relationships with pharmacy network providers, owners, and staff across independent, chain, and specialty pharmacies.Understand and clearly articulate the value of Liviniti network participation for pharmacy providers, including reimbursement methodologies, clinical programs, and our pass-through model.Lead the end-to-end pharmacy contracting process (new contracts, renewals, amendments, and terminations) for assigned pharmacies and groups, ensuring contracts are accurate, compliant, and aligned with Liviniti's financial and service goals.Negotiate favorable but sustainable reimbursement and administrative fee structures with assigned and new pharmacy entities, using claims and performance data to support recommendations.Collaborate with Pharmacy Network Operations, Claims, Clinical Services, Client Services, and Implementation teams to ensure contract terms, rate tables, fees, and network attributes are correctly loaded and maintained in Liviniti systems.Monitor pharmacy network performance and stability for assigned regions or products, including participation status, reimbursement trends, and service issues; escalate and resolve concerns proactively.Respond to and resolve escalated inquiries from pharmacies related to contract terms, reimbursement, claims issues, network requirements, and performance expectations in a timely and professional manner.Support network strategy, RFP responses, and new client implementations by providing network information, completing network-related questionnaires, and assisting with access, gap, and disruption analyses.Assist in the development, rollout, and ongoing management of specialized network products (e.g., preferred networks, health system networks, limited/specialty networks) and related provider communications.Maintain accurate and current contract files, rate schedules, contact lists, and activity documentation in designated tracking tools, databases, and CRM systems to support audit, compliance, and reporting needs.Meet regularly with management, project teams, and functional team leaders within pharmacy network provider groups and employer clients to review performance metrics, provide network updates, collaborate on projects, participate in network management discussions, and resolve issues.Abide by all obligations under HIPAA related to Protected Health Information (PHI).If a HIPAA violation is discovered, whether individually or by another, you must report the violation to the Compliance Officer and/or Human Resources.Attend, complete, and demonstrate competency in all required HIPAA Training offered by the company.Flexibility to understand, appreciate, and embrace that this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.
What We Have to OfferOur benefit package is designed to keep our employees happy and healthy - physically, mentally and financially.
Medical, Dental, Vision InsuranceDisability and Life InsuranceEmployee Assistance ProgramRemote work optionsGenerous Paid-Time OffAnnual Reviews and Development PlansRetirement Plan with company match immediately 100% vested
Required Skills and CompetenciesStrong Knowledge of the PBM industry and pharmacy provider contracting and reimbursement methodologiesKnowledge of PBM claims/systems processesExceptional presentation, written and verbal communication skills Strong quantitative analysis skills Ability to understand detailed contracts and negotiate favorable terms. Ability to work independently and remain on task Good organization and planning skills Ability to prioritize and meet deadlines with multiple projects Advanced level of proficiency with MS Word, Excel
Supervisory Responsibility
The Pharmacy Network and Contracting Specialist will not have supervisory responsibilities or direct reports.
Position Type and Expected Hours of WorkFull-time, salary/exempt position.Some flexibility in hours is allowed, but the employee must be available during the "core" work hours of 8:00 AM to 5:00 PM CT. We cover clients from the West to the East Coast; work times must be adjusted to cover meetings in all time zones. Ability to work extended hours, weekends, and holidays pursuant with industry demands.
TravelThis position could require up to 10% travel from your remote location.
Required Education and ExperienceUndergraduate degree or equivalent experience 3 years of provider relations and/or network management experience Preferred Education and ExperienceMaster's degree2 years of experience in PBM or pharmacy management
Liviniti, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Liviniti, LLC complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Liviniti, LLC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti, LLC employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/D/V
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