Director, PBM Contract Strategy – Engagement

This is a fully remote position, open to applicants in Idaho.

📋 Description

• Provide strategic oversight for pharmacy participation agreements, network addenda, and contract standards, ensuring alignment with enterprise pricing, quality, and access strategies.

• Create and uphold contracting playbooks, standards, and governance frameworks to facilitate negotiations, amendments, and operational applications.

• Collaborate with Legal, Compliance, and Network Pricing leadership to ensure contract structures comply with regulatory requirements and enterprise goals.

• Assist with strategic contract modifications, renewals, and enhancements, emphasizing intent, scalability, and long-term impact over transactional execution.

• Act as a senior contact point for pharmacy providers, chains, and affiliations regarding contract-related issues.

• Foster productive, professional relationships with providers to encourage alignment, transparency, and issue prevention.

• Lead discussions with providers regarding contract interpretation, structural changes, and strategic alignment, escalating only significant or systemic issues.

• Collaborate with Provider Services and Network Leadership to ensure consistent messaging and engagement models for providers.

• Offer strategic guidance on contract interpretation to bolster pricing strategy, claims configuration, and network governance.

• Serve as an escalation point for complex, high-risk, or systemic contract issues, while ensuring routine transaction-level issues are managed operationally.

• Examine trends in provider inquiries or disputes to uncover opportunities for structural contract or process improvements.

• Suggest contract language, governance, or system modifications to minimize recurring operational friction.

• Support Sales and Client Services by providing strategic insights into contract constructs and network positioning.

• Engage in company initiatives related to network strategy, growth, and regulatory preparedness.

• Provide leadership and direction to contract strategy, governance, or senior contract staff, as necessary.

• Establish expectations for quality, consistency, documentation, and escalation discipline.

⛳️ Requirements

• Bachelor’s degree in Business, Finance, Economics, Healthcare Administration, or a related field, or equivalent work experience, is required.

• A minimum of 7 years of progressive experience in PBM, healthcare plans, pharmacy networks, or a related field is required.

• Proven experience in provider contracting, contract strategy, or network governance is required.

• In-depth understanding of pharmacy reimbursement and claims adjudication concepts is required.

• At least 3 years of leadership experience with a demonstrated ability to build high-performing teams and achieve tangible results in a professional services setting is required.

• Participate in, comply with, and support compliance program objectives.

• Ability to consistently interact cooperatively and respectfully with colleagues is essential.

🏝️ Benefits

• Industry-leading benefits for Health, Dental, and Vision insurance

• 20 days of paid time off

• 4 weeks of paid parental leave

• 9 paid holidays

• 401K company match of up to 5% - No vesting requirement

• Adoption Assistance Program

• Flexible Spending Account

• Educational Assistance Plan and support for Professional Memberships

• Referral Bonus Program – up to $750!