Director Pharmacy Benefit Manager

Job description

**This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director Pharmacy Benefit Manager based in the United States.** This senior leadership role will drive the strategic growth and operational management of pharmacy benefit and managed care relationships nationwide. You’ll lead contract evaluation, negotiation, implementation, credentialing, performance monitoring, and renewal activities with major healthcare payers. The position combines PBM expertise, specialty pharmacy reimbursement knowledge, business development, and strategic account management. You’ll work across revenue cycle, operations, billing, pharmacy, compliance, and credentialing teams to ensure sustainable and effective payer partnerships. Your analysis of reimbursement trends, contract performance, and market opportunities will directly support revenue optimization and business growth. You’ll also serve as a senior point of contact for payer relationships and complex operational issues. This remote opportunity offers significant autonomy and strategic influence within a rapidly growing specialty pharmacy environment. ### Accountabilities - Lead the strategic growth and development of the PBM business, including client acquisition, implementation, retention, and expansion initiatives. - Lead the negotiation, implementation, administration, and ongoing management of managed care and PBM agreements across the assigned region. - Manage the full contract lifecycle, including evaluation, negotiation, internal approval, implementation, monitoring, renewal, amendment, and termination. - Develop processes to ensure timely communication of contract terms, reimbursement methodologies, operational requirements, and payer updates to relevant stakeholders. - Analyze contract performance, reimbursement trends, and payer economics to identify revenue optimization and operational improvement opportunities. - Maintain comprehensive knowledge of Medicare, Medicaid, commercial payer reimbursement models, pharmacy benefit structures, and provider payment methodologies. - Serve as the primary point of contact for payer relations and contract performance management. - Build and strengthen relationships with health plans, medical and pharmacy benefit organizations, insurers, employers, third-party administrators, government entities, and other strategic stakeholders. - Collaborate with leadership, revenue cycle, operations, billing, pharmacy, compliance, and credentialing teams to ensure effective contract implementation and ongoing compliance. - Oversee payer credentialing and recredentialing activities to support uninterrupted network participation. - Assist operational teams with payer-related matters, including prior authorizations, eligibility verification, referrals, enrollment requirements, billing issues, and payer education. - Monitor payer adherence to contractual requirements and address reimbursement, operational, or performance concerns as they arise. - Identify market opportunities and support business development initiatives through strategic payer engagement. - Track and communicate payer trends, reimbursement changes, regulatory developments, and network opportunities to leadership. - Represent the organization professionally in interactions with payers, clients, providers, and industry stakeholders. - Maintain strong working relationships across departments and ensure alignment with organizational policies, compliance requirements, regulatory standards, and applicable federal and state laws. - Monitor changes in federal and state regulations affecting managed care contracts and communicate relevant implications to stakeholders. - Provide leadership, responsiveness, and strategic guidance to strengthen the organization's payer and customer relationships. ## Requirements - Bachelor’s degree preferred, or equivalent combination of education and relevant professional experience. - At least 5 years of progressive experience in PBM operations, PBM sales, pharmacy contracting, managed care contracting, or specialty pharmacy leadership. - Demonstrated success negotiating PBM, specialty pharmacy, and managed care agreements. - Strong understanding of specialty pharmacy reimbursement, payer contracting, managed care structures, pharmacy benefit design, and healthcare revenue cycle operations. - Working knowledge of Medicare, Medicaid, and commercial payer reimbursement methodologies. - Experience managing and analyzing contract performance, reimbursement trends, denials, appeals, or related financial and operational data is preferred. - Strong business development and relationship-management capabilities, with the ability to develop productive relationships with healthcare payers and strategic partners. - Excellent negotiation skills and the ability to evaluate contract language, reimbursement structures, operational requirements, and financial implications. - Strong analytical, problem-solving, and decision-making skills. - Excellent written and verbal communication skills, with the ability to communicate complex payer and reimbursement matters clearly. - Highly organized and adaptable, with the ability to multitask, shift priorities, and manage multiple initiatives simultaneously. - Strong customer-service orientation and a professional, responsive approach to internal and external stakeholders. - Ability to work independently while collaborating effectively with cross-functional teams. - Strong knowledge of regulatory and compliance considerations affecting managed care and pharmacy benefit agreements. - Proficiency with standard business and productivity tools. - Willingness to travel approximately 25–30% annually, including attendance at industry conferences approximately 4–6 times per year. - Candidates should ideally reside in a state within the Central or Eastern Time Zone to support business needs and collaboration. ## Benefits - Competitive annual salary of **$150,000–$180,000**, depending on experience and qualifications. - Full-time, remote position. - Standard Monday–Friday schedule, generally **8:00 a.m.–4:30 p.m. Central or Eastern Time**, with some flexibility. - Opportunity to work remotely from locations across the United States, subject to time-zone and business requirements. - Strategic leadership role with significant influence over payer relationships, PBM growth, and contracting strategy. - Opportunity to contribute to specialty pharmacy services supporting patients with chronic and rare illnesses. - Professional growth and career development opportunities. - Collaboration with multidisciplinary teams across pharmacy, operations, revenue cycle, billing, compliance, and credentialing. - Travel opportunities for industry conferences and strategic business engagements. - Mission-driven environment focused on improving access, care, and outcomes for patients with complex healthcare needs.