Director, PBM Specialty Pharmacy Network Contracting

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

📋 Description

• Lead the negotiation of specialty pharmacy participation agreements across various provider segments, encompassing national chains with specialty capabilities, independent specialty pharmacies, and health system-affiliated providers.

• Manage reimbursement frameworks, contract conditions, and financial outcomes for specialty pharmacy agreements, particularly in high-cost drug categories.

• Develop negotiation strategies that harmonize market competitiveness, provider sustainability, and enterprise financial targets within the specialty drug arena.

• Act as the primary decision-maker for contract structures, rate positioning, and high-level negotiation resolutions.

• Approve contract exceptions while ensuring alignment with broader specialty network and enterprise strategies.

• Provide strategic leadership for specialty pharmacy participation agreements, network addenda, and contract standards, ensuring alignment with enterprise pricing, access, and compliance goals.

• Create and maintain contracting playbooks, standards, and governance frameworks to facilitate scalable and consistent negotiation methods.

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

• Suggest improvements to contract language and structure to enhance clarity, enforceability, and long-term viability.

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

⛳️ 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 similar field is required.

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

• A strong understanding of pharmacy reimbursement and claims adjudication principles is required.

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

• Compliance program objectives must be supported, adhered to, and actively participated in.

• The ability to consistently interact in a cooperative and respectful manner with colleagues is essential.

🏝️ 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% with no vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and support for Professional Memberships.

• Referral Bonus Program offering up to $750!