Pharmacy Network Administrator
Company: Magellan Health
Location: Rancho Cordova
Posted on: October 9, 2021
Serves as the departmental resource for assigned credentialing and
contracting projects. Projects range from basic to moderate
complexity. Using advanced systems knowledge and provider
credentialing/contracting information, identifies barriers
impacting on meeting credentialing and contracting requirements,
develops strategies for resolution and facilitates implementation
of a solution. Serves as liaison for external and internal
customers of the Credentialing/Contracting Administration and
payment center information.
- Manages a variety of credentialing and contracting projects
including but not limited to coordination with third-party vendors;
provider communications and liaison; creation, design, testing and
implementation of specific production and audit reports; pharmacy
payment center setup and support; contract rollout and special
- Serves as liaison to field staff for all assigned geographic
locations utilizing knowledge of credentialing and contracting
information and network structure to resolve problems, complaints,
appeals and other provider issues.
- Coordinates state Fee For Service client's pharmacy network
enrollment as assigned.
- Coordinates all EFT and 835 remittance enrollment and issue
- Coordinates problem resolution in areas of risk, facilitate
prioritization of production, and communicates concerns from field
staff and State client contacts.
- Assists with the development of commercial pharmacy networks
within adjudication systems, network database management,
communications database management and RFP responses as assigned by
- Performs other duties as assigned.
1-3 years of experience in data management, credentialing, claims,
insurance administration or health care setting or on the job
Analysis and problem solving skills required.
Ability to interface with multi-disciplinary high level
Ability to identify barriers and elevate issues.
Strong interpersonal and communication skills, both written and
Ability to establish strong relationships and influence work
performance of others.
Intermediate MS Excel and strong skills in other MS Office
products., Bachelors degree preferred.
Pharmacy Benefits Management (PBM), managed care or behavioral
health experience preferred.
Experience utilizing quality improvement methodologies preferred.
Pharmacy Network Administrator
Work Experience - Required
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
Certifications - Required
Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity
Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the
security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and
contractual requirements and internal policies and procedures.
Keywords: Magellan Health, Rancho Cordova , Pharmacy Network Administrator, Other , Rancho Cordova, California
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