Director, PBM Contract Strategy – Engagement

🕒 vor 4 Tagen

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $142.128 - $177.660 / Jahr

⏰ Vollzeit

🔴 Experte

👔 Direktor

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Navitus Health Solutions

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 2003

⚕️ Krankenversicherung

💊 Pharmazie

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions ist ein Anbieter von Apothekenmanagement-Dienstleistungen (Pharmacy Benefit Manager, PBM), der transparente, menschenzentrierte Lösungen für Gesundheitspläne, Arbeitgeber, Regierungsprogramme und andere Plan-Anbieter bereitstellt. Das Unternehmen betreibt ein 100%iges Durchleitungsmodell mit Kostenaufschlag, das darauf abzielt, Medikamentenkosten zu senken, Formulare zu verwalten, Spezialmedikamente zu managen (einschließlich einer Kosten-plus-Spezialapotheke), die Abwicklung von Leistungsansprüchen, Apothekennetzwerk-Management sowie die Unterstützung und Aktivierung von Mitgliedern zu gewährleisten. Navitus positioniert sich als treuhänderischer Partner mit Fokus auf Bezahlbarkeit, Compliance, klinische Qualität und die Verbesserung von Gesundheitsergebnissen durch maßgeschneiderte PBM-Dienstleistungen und digitale Gesundheitsintegrationen.

Beschreibung

• 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.

🎯 Anforderungen

• 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.

🏖️ Vorteile

• 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!