Director, PBM Pharmacy Network Contracting

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

📋 Description

• Lead the negotiation of pharmacy participation agreements across various provider segments, which include national chains, grocers, PSAOs, and independent pharmacy networks.

• Take ownership of reimbursement structures, contract terms, and financial results of pharmacy provider agreements.

• Create negotiation strategies that align market competitiveness with enterprise financial goals and network performance objectives.

• Act as the primary decision-maker for contract structures, rate positioning, and elevated negotiation choices.

• Authorize contract exceptions and ensure alignment with the broader network strategy and pricing goals.

• Provide strategic direction over pharmacy participation agreements, network addenda, and contract standards, ensuring they align with enterprise pricing, access, and compliance objectives.

• Develop and sustain contracting playbooks, standards, and governance frameworks to promote scalable and consistent negotiation practices.

• Guide decisions regarding contract structures to adapt to evolving pricing strategies, regulatory shifts, and market dynamics.

• Lead the provider engagement strategy to foster successful contract negotiations, alignment with contract intent, and long-term network stability.

• Ensure that negotiated contract terms are clearly defined, documented, and positioned for precise downstream implementation.

• Collaborate with Network Operations and Performance teams to facilitate effective handoff, implementation, and validation of contract terms.

• Serve as the escalation point for complex, high-risk, or systemic contract issues that necessitate higher-level leadership intervention.

⛳️ 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.

• Strong understanding of pharmacy reimbursement and claims adjudication concepts is required.

• At least 3 years of leadership experience with a demonstrated ability to cultivate high-performing teams and deliver measurable results in a professional services environment is required.

• Actively participate in, adhere to, and support compliance program objectives.

• Ability to consistently engage cooperatively and respectfully with other employees.

🏝️ Benefits

• Top-tier 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 Professional Membership assistance.

• Referral Bonus Program – up to $750!