Director, PBM PSAO/Indy Pharmacy Network Contracting

🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $142.1k - $177.7k / year

⏰ Full Time

🔴 Lead

💊 Pharmacist

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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

• 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.

🎯 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!