Network Contracting Manager

🕒 July 17

🇺🇸 United States – Remote

💵 $101.3k - $126.7k / year

⏰ Full Time

🟢 Junior

👔 Manager

🚫👨‍🎓 No degree required

👻 Ghost score 14%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

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

• Manage retail, specialty, and mail order pharmacy contracting, issue management, reporting, and network strategy • Develop, implement, execute, and provide ongoing management of pharmacy contracts and relationships with pharmacy partners • Evaluate the value obtained from each pharmacy contract on behalf of Navitus and payers • Ensure compliance with contractual obligations, state and federal regulations, and network requirements • Address reimbursement issues and determine pharmacy network needs • Evaluate prospective providers • Manage pharmacy and vendor contract negotiations • Negotiate pharmacy network reimbursement and execute pay-for-performance contracts • Ensure pharmacy networks comply with regulatory and contractual obligations for value-based, quality, and performance initiatives • Work with clinical teams to identify applicable pharmacy-service quality measures • Audit pharmacy quality performance networks and related performance guarantees and metrics • Interpret data models to establish market-competitive pricing • Determine pharmacy network reimbursement pricing structures • Review, recommend, and update pharmacy participation agreements and network addendums • Resolve pharmacy contract issues • Develop value propositions to payers for preferred, narrow, specialty, and limited-distribution pharmacy networks • Participate in related pharmacy projects, initiatives, and administrative duties

🎯 Requirements

• Bachelor’s degree or higher in a related field is preferred • Minimum 1 - 3 years PBM or Managed Care experience is highly desired • Prior experience managing vendors or accounts is preferred • Understanding of managed care, retail, and specialty pharmacy network concepts and PBM plan designs is highly desired • Experience with CMS, Medicare, and state Medicaid regulations and guidance is preferred • Knowledge of health care processes and pharmaceutical claims adjudication systems • Participate in, adhere to, and support compliance program objectives • Ability to consistently interact cooperatively and respectfully with other employees • Remote work is unavailable to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming

🏖️ 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! • STAR Bonus % (At Risk Maximum) 5.00