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Director, PBM PSAO/Indy Pharmacy Network Contracting
Location
Idaho
Posted
3 days ago
Salary
$142.1K - $177.7K / year
Seniority
Lead
Job Description
Director, PBM PSAO/Indy Pharmacy Network Contracting
Navitus Health Solutions
• Lead negotiation of pharmacy participation agreements across all provider segments, including chains, grocers, PSAOs, and independent pharmacy networks. • Own reimbursement structures, contract terms, and financial outcomes of pharmacy provider agreements. • Establish negotiation strategies that balance market competitiveness with enterprise financial and network performance goals. • Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions. •Approve contract exceptions and ensure alignment to broader network strategy and pricing objectives. • Provide strategic leadership over pharmacy participation agreements, network addenda, and contract standards, ensuring consistency with enterprise pricing, access, and compliance objectives. • Develop and maintain contracting playbooks, standards, and governance frameworks to support scalable and consistent negotiation practices. • Guide contract structure decisions to support evolving pricing strategies, regulatory changes, and market dynamics. • Recommend enhancements to contract language and structure to improve clarity, enforceability, and long-term sustainability. • Lead provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability. • Serve as a senior point of contact for complex and strategic provider discussions, including reimbursement changes, contract interpretation, and structural alignment. • Maintain strong relationships with key pharmacy partners to support transparency, issue prevention, and alignment on contract expectations. • Drive resolution of high-impact or systemic provider issues, ensuring alignment to contract terms and enterprise objectives. • Ensure negotiated contract terms are clearly defined, documented, and positioned for accurate downstream implementation. • Partner with Network Operations and Performance teams to support effective handoff, implementation, and validation of contract terms. • Provide strategic guidance on contract interpretation to support claims configuration, pricing application, and network governance. • Support enterprise initiatives related to network strategy, growth, and regulatory readiness. • Accountable for financial performance of pharmacy network contracts, ensuring negotiated reimbursement terms align with enterprise pricing strategy and expected outcomes. • Partner with Network Performance and Reconciliation leadership to ensure contracted terms are operationalized and achieved through effective execution and monitoring. • Incorporate performance insights and market feedback into future negotiation strategies and contract design decisions. • Act as escalation point for complex, high-risk, or systemic contract issues requiring higher-level leadership intervention. • Analyze trends in provider inquiries, disputes, and operational friction to identify opportunities for structural contract improvement. • Drive continuous improvement initiatives to enhance contract clarity, reduce administrative burden, and improve provider experience. • Provide leadership and direction to contract managers and/or senior contracting staff. • Set expectations for negotiation discipline, contract quality, documentation, and escalation standards. • Foster a high-performing team environment focused on accountability, consistency, and execution excellence.
Job Requirements
- Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration, or related field, or equivalent work experience, required.
- 7+ years of progressive PBM, healthcare plan, pharmacy network, or equivalent experience required.
- Demonstrated experience in provider contracting, contract strategy, or network governance required.
- Experience with PSAO/Indy contracting strongly preferred.
- Strong understanding of pharmacy reimbursement and claims adjudication concepts required.
- 3+ years of leadership experience with a proven ability to develop high-performing teams and deliver tangible results in a professional services environment required.
- Participate in, adhere to, and support compliance program objectives.
- The ability to consistently interact cooperatively and respectfully with other employees.
Benefits
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks 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!
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