Director, PBM Pharmacy Network Contracting

🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $142.1k - $177.7k / year

⏰ Full Time

🔴 Lead

💊 Pharmacist

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Lead negotiation of pharmacy participation agreements across all provider segments, including national 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. • Lead provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability. • 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. • Act as escalation point for complex, high-risk, or systemic contract issues requiring higher-level leadership intervention.

🎯 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!