Pharmacy Network Contracting Manager

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

📋 Description

• Oversee daily pharmacy contracting operations as the primary subject matter expert.

• Provide guidance and mentorship to team members on processes.

• Manage and enhance the contracting pipeline, which includes intake, prioritization, aging, execution timelines, and deliverables.

• Supervise the complete contract lifecycle for new agreements, amendments, renewals, notices, and terminations.

• Lead intricate contract negotiation processes and redline reviews in collaboration with Legal and internal stakeholders.

• Ensure that reimbursement exhibits, fee schedules, and effective dates are precise, approved, and ready for implementation.

• Facilitate rate loading and network configuration in the claims adjudication system.

• Design and enforce quality assurance frameworks for rate setup, plan/network mapping, reimbursement logic, and exception management.

• Monitor and prioritize the rate load/configuration backlog, escalating risks that may impact go-lives or claims outcomes.

• Manage post-load validation, test claims, spot checks, variance reviews, issue triage, root cause analysis, and any necessary corrections.

• Collaborate with Provider Relations on contracting timelines, onboarding requirements, and communication with providers.

• Address provider escalations related to contracting and configuration.

• Create and maintain contracting playbooks, standard operating procedures (SOPs), templates, clause guidance, and standardized responses.

• Oversee the contract repository and configuration documentation, including version control and change history.

• Report on contracting/configuration volume, cycle times, backlog, and trends in issues.

• Promote continuous process improvement and uphold a contracting knowledge base.

⛳️ Requirements

• Bachelor’s degree or equivalent experience relevant to PBM, managed care, healthcare contracting, network operations, or provider relations.

• Over 8 years of experience in pharmacy/provider contracting, PBM network operations, or healthcare contract administration.

• At least 2 years of experience acting as a principal subject matter expert, process owner, and/or managing high-volume contracting workflows.

• Exceptional capability to interpret complex contract language, lead redline negotiations, and recognize business, operational, and compliance risks.

• Profound technical knowledge of claims adjudication and pharmacy reimbursement configuration.

• Experience in designing or overseeing rate loading and configuration accuracy, including effective-date controls and mapping requirements.

• Ability to resolve issues faced by providers while balancing contracting standards and operational feasibility.

• Advanced skills in cross-functional stakeholder management across Provider Relations, Legal, Pricing, Credentialing, Operations, Compliance, and Finance.

• Excellent written and verbal communication abilities.

• Exceptional attention to detail and the capacity to manage competing priorities and deadlines independently.

• Advanced proficiency in Excel/Google Sheets and contract tracking/document management practices.

• Preferred experience in PBM pharmacy networks (retail, PSAO/independents, specialty).

🏝️ Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance along with AD&D Insurance.

• Flexible Spending Benefits.

• 401(k) Retirement Savings Program.

• Short-term and long-term disability coverage.

• Discretionary Paid Time Off.

• Paid Company Holidays.

• Wellness Benefits.

• Commuter Benefits.

• Paid Parental Leave benefits.

• Employee Assistance Program (EAP).

• Well-stocked kitchen in office locations.

• Opportunities for professional development and training.

• Potential bonuses, commissions, or equity.

• Time off programs.

• Support for mental health.