Director, Contract Strategy – Provider Engagement

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🔥 2 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $142.1k - $177.7k / year

⏰ Full Time

🔴 Lead

👔 Director

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Provide strategic leadership over pharmacy participation agreements, network addenda, and contract standards, ensuring consistency with enterprise pricing, quality, and access strategies. • Develop and maintain contracting playbooks, standards, and governance frameworks to guide negotiations, amendments, and operational application. • Partner with Legal, Compliance, and Network Pricing leadership to ensure contract structures align with regulatory requirements and enterprise objectives. • Support strategic contract amendments, renewals, and enhancements, focusing on intent, scalability, and long‑term impact, rather than transactional execution. • Serve as a senior point of engagement for pharmacy providers, chains, and affiliations on contract‑related matters. • Maintain productive, professional relationships with providers to support alignment, transparency, and issue prevention. • Lead provider discussions related to contract interpretation, structural changes, and strategic alignment, escalating only high‑impact or systemic issues. • Partner with Provider Services and Network Leadership to ensure consistent provider messaging and engagement models. • Provide strategic guidance on contract interpretation to support pricing strategy, claims configuration, and network governance. • Act as an escalation point for complex, high‑risk, or systemic contract issues, while ensuring routine transaction‑level issues are handled operationally. • Analyze trends in provider inquiries or disputes to identify structural contract or process improvement opportunities. • Recommend contract language, governance, or system changes to reduce recurring operational friction. • Support Sales and Client Services by providing strategic clarity on contract constructs and network positioning. • Participate in company initiatives related to network strategy, growth, and regulatory readiness. • Provide leadership and direction to contract strategy, governance, or senior contract staff, as applicable. • Set expectations for quality, consistency, documentation, and escalation discipline. • Other duties as assigned.

🎯 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. • 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!