ChristianaCare is seeking a Pharmacy Contract Specialist to conduct and coordinate the day-to-day contracting activities for Pharmacy Services in collaboration with the Managed Care Contracting Department. This position will be responsible for enhancing revenue by developing and maintaining significant contracts with third-party payors, primarily Managed Care Organizations (Blue Cross and Blue Shield, Aetna, Coventry, etc.) in accordance with CCHS policies.
The Pharmacy Contract Specialist will also work closely with key partners across the organization to coordinate and facilitate execution of pharmaceutical contracts for Pharmacy Services. This includes contracts for specialty pharmacy, our retail pharmacies, and employee Mail Order pharmacy. This position will also maintain and analyze information vital to the proper classification, evaluation, and quality of successful contracts focusing on brand, generic, and specialty medications. The Specialist will also promote successful contract performance by preventing and resolving problems and participate in the pharmacy supply chain sourcing team's strategic planning, preparation, and reporting.
A secondary function is to provide oversight and supervision of the business process of contracts processed through the legal department.
The ChristianaCare Way!
When you become an employee at ChristianaCare, you are joining a healthcare organization that was named Forbes 5th Best Health System to Work for in the U.S. for 2021! Guided by excellence and love, our Caregivers enjoy many employee benefits such as
Maintains and updates Pharmacy Services contracts for both specialty and retail pharmacy. Informs stakeholders of changes and responds to questions/concerns
Provides business analytics and decision support for key sourcing activities and provides ongoing spend / value reporting
Work in collaboration with members of the managed care team to evaluate value based contracts that cross inpatient, outpatient and specialty operations lines
Acts as a subject matter authority in the requirements, rules and regulations of third-party and government payers. Understands eligibility requirements and authorization requirements of insurance company plans, Medicare, Medicaid, and how each program/payer reimburses
Reconciles post-award execution such as price challenges, auditing, quality concerns, Accounts Payable issues, rebate payments from vendors, answers general questions from customers and vendors
Is a relevant leader with vision and active contributor to the business by maintaining a solid understanding of pharmacy contracting, supplier capabilities, market trends, and technological advances in all aspects of pharmaceutical contracting including manufacturing, wholesaler, 340B and GPO contract structures
Collaborates on the development and optimization of key sourcing and cost management tools and systems
Recommends Pharmacy Services policies and procedures related to third-party contracts/agreements
Reviews both simple and sophisticated contracting opportunities for cost savings or clinical improvements
Supervises and leads the business process of contract execution in collaboration with the legal department
Partners with finance and decision support teams to build and maintain analytic models that enable the development and evaluation of various value-based models in new and existing markets
Engages our Legal & Risk Management team in the development of contract templates and serves as a subject matter expert on the execution of these contracts. Has a working familiarity with and consults on regional and cross-border regulatory and compliance issues, as it impacts participating provider contracts and practice operations across Delaware, Maryland, Pennsylvania, and New Jersey
Is adaptive and able to perform multiple roles - leader, consultant, advisor - depending upon the nature and scope of the project
Conducts performance and payment audits to ensure adherence to accreditation and regulatory requirements
Investigates denials and coordinates appeals. Recommends changes to procedures to prevent denials
Supervises key metrics for the Pharmacy Services PI committee and pharmacy leadership
Education and experience requirements:
Minimum 3 years background / experience in retail, specialty or hospital pharmacy required
Bachelor's degree required (focus in business, healthcare, or accounting preferred)
Master's in business administration, healthcare administration or contracting preferred
Minimum 3 years' experience with third-party negotiations required
Familiarity with health system revenue cycle required
Minimum 3 years' experience in Pharmacy Supply Chain required
EEO Statement: Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.
UPDATE: ChristianaCare is committed to prioritizing the health and safety of our patients and caregivers. As we continue to meet the needs of our caregivers and our community through the COVID-19 pandemic, our commitment to health and safety requires that we take new steps to ensure a safe environment for medical care for our patients and a workplace that avoids preventable harm for our caregivers. For this reason, vaccination for COVID-19 is required for all caregivers at ChristianaCare and is considered a safety standard that is job-related and consistent with business necessity for all caregivers.
ChristianaCare Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are ...positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.