Manager, Pricing and Network Administrator at WellDyne

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Full Time

Start Date

Immediate

Expiry Date

16 Jun, 26

Salary

0.0

Posted On

18 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Team Management, Pricing Strategy, Network Administration, Reimbursement Methodologies, Policy Development, Procedure Execution, Financial Performance, Compliance, NetCard Systems, RxClaim Configuration, Formula Optimization, Credentialing Standards, URAC Requirements, Standard Operating Procedures, Excel, SQL

Industry

Hospitals and Health Care

Description

At our company, we move fast, adapt quickly, and turn challenges into opportunities—all while keeping quality at the heart of everything we do. We believe that work should be a positive and respectful place, and that with the right mindset, anything is achievable. Our Vision: Unlocking the full potential of pharmacy care management to empower people to live healthier, happier lives. Our Mission: To drive pharmacy care that builds trust, improves outcomes and puts people first. Summary Responsible for leading the strategy, operations, and team management related to pharmacy network pricing and reimbursement. Oversees the development and execution of policies, procedures, and systems that support accurate pricing setup, reimbursement methodologies, financial performance, and compliance across the retail pharmacy network. Essential Duties & Responsibilities * Direct oversight of the NetCard Systems and Pricing Operations team members, ensuring timely and accurate delivery of pricing and reimbursement activities * Manage pharmacy network composition and reimbursement structures * Facilitate RxClaim pricing configuration for both clients and pharmacies, ensuring alignment with contractual and operational requirements * Monitor and optimize pharmacy reimbursement formulas to support margin improvement and financial risk mitigation * Ensure compliance with credentialing standards and URAC requirements through coordinated operational processes * Maintain and enforce standard operating procedures related to pricing and reimbursement operations * Hire, train, and develop team members to support operational excellence and continuous improvement * Perform other duties as assigned Education and Experience * Bachelor’s Degree from an accredited college preferred or 5+ years PBM industry experience Knowledge, Skills, and Abilities * Ability to communicate with all levels of management in an effective manner * Excellent organization and time management skills * Ability to work with confidential information * Ability to manage multiple projects simultaneously * Demonstrated ability to lead in an environment where priorities may change and deadlines must be met without sacrificing accuracy * Advanced proficiency in Excel (Experience with all Lookup and Logic formulas required) * Proficiency in SQL or Tableau is preferred * Must be able to contribute independently as well as support and contribute to the achievement of team goals Work Environment / Physical Demands This position is in a typical office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. May have occasional high stress when dealing with customers/clients. Some travel may be required. EOE M/F/D/V – WellDyne and HealthDyne are equal opportunity employer and prohibits discrimination of any kind. All employment decisions are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, veteran or disability status, or any other protected status under federal, state, or local law.

Responsibilities

This role is responsible for leading the strategy, operations, and team management concerning pharmacy network pricing and reimbursement activities. Key duties include overseeing the development and execution of systems and procedures for accurate pricing setup, reimbursement methodologies, financial performance, and compliance across the retail pharmacy network.