Director, PBM PSAO/Indy Pharmacy Network Contracting

Role Overview

• Lead negotiation of pharmacy participation agreements across all provider segments, including chains, grocers, PSAOs, and independent pharmacy networks.
• Own reimbursement structures, contract terms, and financial outcomes of pharmacy provider agreements.
• Establish negotiation strategies that balance market competitiveness with enterprise financial and network performance goals.
• Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions.
• Approve contract exceptions and ensure alignment to broader network strategy and pricing objectives.
• Provide strategic leadership over 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 provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability.
• Serve as a senior point of contact for complex and strategic provider discussions, including reimbursement changes, contract interpretation, and structural alignment.
• Maintain strong relationships with key pharmacy partners to support transparency, issue prevention, and alignment on contract expectations.
• Drive resolution of high-impact or systemic provider issues, ensuring alignment to contract terms and enterprise objectives.
• Ensure negotiated contract terms are clearly defined, documented, and positioned for accurate downstream implementation.
• Partner with Network Operations and Performance teams to support effective handoff, implementation, and validation of contract terms.
• Provide strategic guidance on contract interpretation to support claims configuration, pricing application, and network governance.
• Support enterprise initiatives related to network strategy, growth, and regulatory readiness.
• Accountable for financial performance of pharmacy network contracts, ensuring negotiated reimbursement terms align with enterprise pricing strategy and expected outcomes.
• Partner with Network Performance and Reconciliation leadership to ensure contracted terms are operationalized and achieved through effective execution and monitoring.
• Incorporate performance insights and market feedback into future negotiation strategies and contract design decisions.
• Act as escalation point for complex, high-risk, or systemic contract issues requiring higher-level leadership intervention.
• Analyze trends in provider inquiries, disputes, and operational friction to identify opportunities for structural contract improvement.
• Drive continuous improvement initiatives to enhance contract clarity, reduce administrative burden, and improve provider experience.
• Provide leadership and direction to contract managers and/or senior contracting staff.
• Set expectations for negotiation discipline, contract quality, documentation, and escalation standards.
• Foster a high-performing team environment focused on accountability, consistency, and execution excellence.

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.
• Experience with PSAO/Indy contracting strongly preferred.
• 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!