Director, PBM Contract Strategy – Engagement

Role Overview

• Provide strategic leadership over pharmacy participation agreements, network addenda, and contract standards, ensuring consistency with enterprise pricing, quality, and access strategies.
• Develop and maintain contracting playbooks, standards, and governance frameworks to guide negotiations, amendments, and operational application.
• Partner with Legal, Compliance, and Network Pricing leadership to ensure contract structures align with regulatory requirements and enterprise objectives.
• Support strategic contract amendments, renewals, and enhancements, focusing on intent, scalability, and long‑term impact, rather than transactional execution.
• Serve as a senior point of engagement for pharmacy providers, chains, and affiliations on contract‑related matters.
• Maintain productive, professional relationships with providers to support alignment, transparency, and issue prevention.
• Lead provider discussions related to contract interpretation, structural changes, and strategic alignment, escalating only high‑impact or systemic issues.
• Partner with Provider Services and Network Leadership to ensure consistent provider messaging and engagement models.
• Provide strategic guidance on contract interpretation to support pricing strategy, claims configuration, and network governance.
• Act as an escalation point for complex, high‑risk, or systemic contract issues, while ensuring routine transaction‑level issues are handled operationally.
• Analyze trends in provider inquiries or disputes to identify structural contract or process improvement opportunities.
• Recommend contract language, governance, or system changes to reduce recurring operational friction.
• Support Sales and Client Services by providing strategic clarity on contract constructs and network positioning.
• Participate in company initiatives related to network strategy, growth, and regulatory readiness.
• Provide leadership and direction to contract strategy, governance, or senior contract staff, as applicable.
• Set expectations for quality, consistency, documentation, and escalation discipline.

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!