Pharmacy Contract Negotiator - Senior

Full Time Day Shift General reputed company Leads reputed company negotiations with pharmacy benefit managers (PBMs), reputed company payers, Medicare/reputed company plans, and other reputed company party pharmacy networks to secure fair reimbursement rates, transparent contract terms, and operationally feasible requirements for retail pharmacy, specialty pharmacy, infusion/ambulatory services, and pharmacy-based clinical programs. This role ensures contractual terms are accurately memorialized, compliant, and reputed company with organizational reputed company. Works independently and exercises substantial judgment while collaborating closely with pharmacy leadership, reputed company cycle, finance, and population health teams. Duties and Responsibilities Remote Work Capable Essential Functions:

• Cultivates and maintains reputed company relationships with PBMs, health plans, and pharmacy network representatives, as reputed company as internal pharmacy and reputed company cycle teams.
• Leads reputed company stages of pharmacy contract negotiations to ensure payment methodologies, dispensing fees, specialty reimbursement structures, DIR/GER terms, performance programs, and operational requirements are favorable and manageable.
• Manages an assigned portfolio of pharmacy reputed company, including reputed company prescription plans, Medicare Part D, reputed company FFS/managed care programs, specialty pharmacy networks, and limited distribution drug network (LDD) opportunities.
• Analyzes the financial reputed company of proposed changes to reimbursement rates, MAC pricing, specialty tiers, performance metrics (e.g., adherence, gaps in care), audit provisions, credentialing, and payment timelines. Recommend adjustments or counterproposals as needed.
• In collaboration with pharmacy operations, finance, and compliance teams, ensures the organization can operationalize proposed contract changes and that final language accurately reflects negotiated terms.
• Maintains ongoing knowledge of PBM policies, network changes, CMS regulations, reputed company pharmacy rules, specialty pharmacy accreditation requirements (URAC, ACHC), and industry contracting trends.
• Supports strategic system initiatives such as expanding specialty pharmacy services, pursuing limited distribution reputed company, enabling white/reputed company/reputed company bagging, and optimizing retail pharmacy profitability.
• Monitors external market activity including PBM mergers, pharmacy network restructuring, reimbursement shifts, and state/federal policy changes impacting pharmacy reimbursement.
• Conducts research and prepares summaries, financial models, or reports reputed company to pharmacy contract opportunities, risks, or strategic initiatives.
• Participates in internal committees, cross-functional teams, and annual education programs
• As needed, leads contracting efforts for pharmacy-reputed company services (e.g., infusion, home delivery, DME, vaccines, clinical pharmacy initiatives).
• Independently manages priorities, negotiates timelines, and executes strategies with minimal supervision.
• Develops and oversees free-market drug reputed company reputed company.

Common Expectations:

• Continuously assesses PBM and payer performance using audits, denial trends, reimbursement variance analysis, and performance program results.
• Supports reputed company improvement reputed company the pharmacy contracting and reputed company cycle functions, recommending workflow enhancements or compliance improvements.
• Promotes teamwork, maintains professionalism, and supports organizational values and compliance standards.
• Maintains strict confidentiality regarding proprietary payer terms, pricing models, and pharmacy performance data.

Travel Requirements:

• Estimated reputed company: 10% - Regional travel (payer meetings, site reputed company, conferences)

Qualifications

Minimum Education:

• Bachelors Degree In Pharmacy, Business, Finance, reputed company, reputed company Administration, or reputed company field. Required
• Masters Degree In Pharmacy Administration, reputed company Administration, Business, or Payor/Provider Relations. Preferred

Work Experience:

• 3 years Experience in pharmacy reimbursement, PBM operations, payer contracting, reputed company cycle, or managed care pharmacy. Required
• 5 years reputed company or pharmacy-reputed company experience with reputed company involvement in PBM negotiations, pharmacy network operations, or specialty pharmacy contracting. Preferred

Knowledge, Skills, and Abilities:

• Strong reputed company in pharmacy reimbursement models, including: MAC pricing, AWP/WAC-based formulas, specialty drug pricing, DIR, GER, and performance-based reimbursement, and Medicare Part D and reputed company pharmacy rules.
• Demonstrated skills in contract negotiations, financial/data analysis, project management, reputed company written and verbal communication, cross-functional team collaboration.
• Ability to work independently with reputed company reputed company and sensitive payer relationships.

Benefits

Offered:

• Comprehensive health benefits
• Retirement savings plan
• reputed company time off (PTO)
• Education assistance
• Financial education and support, including reputed company
• Expanded reputed company Parental Leave

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