Director, PBM Specialty 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 specialty pharmacy participation agreements across all provider segments, including national chains with specialty capabilities, independent specialty pharmacies, and health system–affiliated providers. • Own reimbursement structures, contract terms, and financial outcomes for specialty pharmacy agreements, including high-cost drug categories. • Establish negotiation strategies that balance market competitiveness, provider sustainability, and enterprise financial objectives within the specialty drug landscape. • Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions. • Approve contract exceptions and ensure alignment to broader specialty network and enterprise strategy. • Provide strategic leadership over specialty 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 specialty provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability.

🎯 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!