Pharmacy Network Contracting Manager
Core
Principal process owner for pharmacy network contracting operations, managing the pipeline, governance, and execution of agreements to improve throughput and accuracy.
Role type
Senior IC pharmacy network contracting manager
Builds
Pharmacy network agreements, reimbursement exhibits, fee schedules, and system configurations for claims adjudication
Domain
Healthcare / Pharmacy Benefit Management (PBM)
Required skills
pharmacy network contracting, contract lifecycle management, contract negotiation, claims adjudication configuration, rate loading, QA frameworks, stakeholder management, data analysis, process improvement, documentation governance
Preferred skills
PBM pharmacy network experience (retail, PSAO/independents, specialty)
Responsibilities
Lead day-to-day pharmacy contracting operations and optimize the contracting pipeline; Govern the end-to-end contract lifecycle including new agreements, amendments, renewals, and terminations; Lead complex contract negotiation workflows and redline reviews; Ensure accurate reimbursement exhibits, fee schedules, and effective dates; Drive rate loading and network configuration in the claims adjudication system; Architect and enforce controls and QA frameworks for rate setup; Monitor and manage the rate load/configuration backlog; Own post-load validation checkpoints and lead root-cause analysis; Partner with Provider Relations to align timelines and onboarding requirements; Act as the escalation point for contracting-related provider issues; Author and maintain contracting playbooks, SOPs, and templates; Drive contract repository and configuration documentation governance; Leverage data to provide routine reporting and lead continuous process improvement initiatives; Architect and maintain a comprehensive contracting knowledge base
Seniority
Senior, hands-on IC