Pharmacy Network Contracting Manager

🔥 18 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

💊 Pharmacist

👻 Ghost score 10%

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SmithRx

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2018

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $20M Series B on 2022-03

Consulting • Insurance • Healthcare

SmithRx is a transparent, pass-through pharmacy benefits manager (PBM) that operates independently from insurance companies and pharmacies to align its incentives with self-insured employers and their members. By leveraging modern technology, SmithRx aims to reduce the cost and complexity of pharmacy benefits, ensuring the delivery of effective and low-cost drugs. The company is dedicated to transforming the pharmacy benefits landscape through its flat-rate, transparent pricing model and innovative cost savings programs, which connect members to the lowest cost drugs without the use of spread pricing, rebates, or other tactics. SmithRx's commitment to transparency and superior customer service results in significant savings for employers and a highly satisfactory experience for its members.

📋 Description

• Lead day-to-day pharmacy contracting operations as the principal subject matter expert • Provide mentorship and process guidance to team members • Own and optimize the contracting pipeline, including intake, prioritization, aging, execution timelines, and deliverables • Govern the end-to-end contract lifecycle across new agreements, amendments, renewals, notices, and terminations • Lead complex contract negotiation workflows and redline reviews with Legal and internal stakeholders • Ensure reimbursement exhibits, fee schedules, and effective dates are accurate, approved, and implementation-ready • Drive rate loading and network configuration in the claims adjudication system • Architect and enforce QA frameworks for rate setup, plan/network mapping, reimbursement logic, and exception handling • Monitor and prioritize the rate load/configuration backlog and escalate risks affecting go-lives or claim outcomes • Own post-load validation, test claims, spot checks, variance reviews, issue triage, root-cause analysis, and corrections • Partner with Provider Relations on contracting timelines, onboarding requirements, and provider communications • Resolve contracting- and configuration-related provider escalations • Author and maintain contracting playbooks, SOPs, templates, clause guidance, and standard responses • Govern contract repository and configuration documentation, including version control and change history • Report on contracting/configuration volume, cycle time, backlog, and issue trends • Lead continuous process improvement and maintain a contracting knowledge base

🎯 Requirements

• Bachelor’s degree or equivalent relevant experience in PBM, managed care, healthcare contracting, network operations, or provider relations • 8+ years of experience in pharmacy/provider contracting, PBM network operations, or healthcare contract administration • 2+ years of experience serving as a principal subject matter expert, process owner and/or managing high-volume contracting workflows • Exceptional ability to interpret complex contract language, lead redline negotiations, and identify business, operational, and compliance risks • Deep technical understanding of claims adjudication and pharmacy reimbursement configuration • Experience architecting or overseeing rate loading and configuration accuracy, including effective-date controls and mapping requirements • Ability to resolve provider-facing issues while balancing contracting standards and operational feasibility • Advanced cross-functional stakeholder management across Provider Relations, Legal, Pricing, Credentialing, Operations, Compliance, and Finance • Excellent written and verbal communication skills • Meticulous attention to detail and ability to autonomously manage competing priorities and deadlines • Advanced proficiency with Excel/Google Sheets and contract tracking/document management practices • PBM pharmacy network experience (retail, PSAO/independents, specialty) preferred

🏖️ Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance • Flexible Spending Benefits • 401(k) Retirement Savings Program • Short-term and long-term disability • Discretionary Paid Time Off • Paid Company Holidays • Wellness Benefits • Commuter Benefits • Paid Parental Leave benefits • Employee Assistance Program (EAP) • Well-stocked kitchen in office locations • Professional development and training opportunities • Bonuses, commissions, or equity may be available • Time off programs • Mental health support