Director, PBM Specialty Pharmacy Network Contracting
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Job Description
Director leading specialty pharmacy network contracting negotiations and management. Focused on ensuring competitive contract terms within Navitus's healthcare framework.
Responsibilities:
- Lead negotiation of specialty pharmacy participation agreements across all provider segments, including national chains with specialty capabilities, independent specialty pharmacies, and health system–affiliated providers.
- Own reimbursement structures, contract terms, and financial outcomes for specialty pharmacy agreements, including high-cost drug categories.
- Establish negotiation strategies that balance market competitiveness, provider sustainability, and enterprise financial objectives within the specialty drug landscape.
- Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions.
- Approve contract exceptions and ensure alignment to broader specialty network and enterprise strategy.
- Provide strategic leadership over specialty 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 specialty provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability.
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!
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