The mission of University of Washington Medicine is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow's physicians, scientists and other health professionals. UW Medicine owns or operates the following: Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center, a network of UW Medicine Neighborhood Clinics that provide primary care, UW Physicians, UW School of Medicine, Airlift Northwest, and other owned, operated, or affiliated entities as appropriate. In addition, UW Medicine shares in the ownership and governance of Children's University Medical Group and Seattle Cancer Care Alliance a partnership among UW Medicine, Fred Hutchinson Cancer Research, and Seattle Children's.
The University of Washington is proud to be one of the nation's premier educational and research institutions. Our people are the most important asset in our pursuit of achieving excellence in education, research, and community service. Our staff not only enjoys outstanding benefits and professional growth opportunities, but also an environment noted for diversity, community involvement, intellectual excitement, artistic pursuits, and natural beauty. As an employee, you will enjoy generous benefits and work/life programs. For a complete description of our benefits for this position, please view this page.
UW Medicine Pharmacy has an outstanding opportunity for a FULL-TIME SPECIALTY PHARMACY CONTRACTING MANAGER. The Specialty Pharmacy Contracting Manager is responsible for establishing specialty pharmacy payer contracts on behalf of each partnering health system. The manager will focus on establishing new and managing existing contracts to include specialty pharmacy services for UW Medical Center and Harborview Medical Center. The Pharmacy Contracting Manager will be responsible for managing relationships with payers, third-party administrators, and employer groups. Focused activities will include proposal development, fee schedule analysis, and negotiation of rates and contract terms to maximize reimbursement. The Specialty Pharmacy Contracting Manager is responsible for negotiating with drug manufacturers for access to limited-distribution drugs.
The Specialty Pharmacy Contracting Manager position requires knowledge of pharmacy retail contracting. The Manager will be responsible for building relationships and negotiating with drug manufacturers, third-party administrators, payers, and other contracting groups. Contract analysis and development is a requirement of the position. Access to limited-distribution drugs requires an additional subset of analysis and proposal to drug manufacturers. The position requires knowledge of Specialty Pharmacy regulatory requirements and retail pharmacy operations, financial analysis, and modeling.
DUTIES & RESPONSIBILITIES:
Pharmacy Contracting Program Management:
Source specialty pharmacy and retail pharmacy payer contracts on behalf of each retail pharmacy network.
Source limited-distribution drug contracts with drug manufacturers on behalf of each retail pharmacy network. Participate in negotiations with our partners while building strong industry relationships with specialty pharmacy benefit payers.
Assist in the development of comparative analysis related to patient total cost of care using reliable skill set in statistical analysis.
Provide explanation and interpretation of contracts to internal and external customers.
Responsible for the strategic development and implementation of specialty pharmacy benefit payer strategies.
Work closely with legal and business teams to ensure contract language accurately conveys intent.
Work with the team on state licensing matters, including new applications, credentialing, and re-credentialization.
Work with team on assessment of reporting requirements.
Provide clear channels of communication, delegation, and accountability within the team for effective direction and problem-solving.
Participate in the development, implementation, and evaluation of policies and procedures for the Specialty Pharmacy Program. Assist the Specialty Pharmacy team in the development of new policies and procedures and assure timely review and revision of procedures as the program expands. Assure that all program policies and procedures meet state and federal regulations.
Communicate third-party payer changes to the pharmacy team and track/forecast the impact of changes.
Contract redlining, including reviewing contract rates, (Acquisition and AWP pricing) to determine a profitable margin.
Document control and following the legal contract procedure from initial receipt of the agreement to final execution.
Communicate new contracts with finance and revenue cycle teams, as well as contract pricing for PBMs and other payer contracts (managed care plans and medical groups).
Provide contract, grant, and price file surveillance to maintain current coding, rate changes, and ensure contract and regulatory compliance.
The Specialty Pharmacy Contracting Manager will also:
Perform other duties as assigned.
Follow UW Medicine security and confidentiality policies and procedures.
Maintain current professional standards and credentials through study materials and education to stay abreast of continuous changes in the healthcare industry.
Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.