Hybrid Pharmacy Benefits Manager – Managed Care Contracts

Sentara Health Plans; Virginia Beach (VA); Hybrid; USD 110,000 - 140,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Parental & family leave

401k with employer match

Tuition assistance

CEU access

Pet insurance

Legal resources

Job summary

Sentara Health Plans is seeking a Manager, Managed Care Contracting to lead medical and pharmacy managed care contracting strategies for assigned payors. You will collaborate with clinical, pharmacy, and managed care leadership to optimize reimbursement, ensure contract performance, and align financial goals.

The role involves negotiating terms, analyzing contracts, and supporting day-to-day managed care operations, including patient access and claims adjudication.

Qualifications

• Understanding of pharmacy benefit management (PBM) structures and reimbursement models.
• Experience negotiating pharmacy reimbursement terms and specialty pharmacy agreements.
• Knowledge of formulary management, utilization management, and drug pricing strategies.
• Strong financial acumen with experience in contract modeling and reimbursement analysis.

Responsibilities

• Lead managed care contracting strategies and activities for assigned payors.
• Collaborate with clinical, pharmacy and managed care leadership to optimize reimbursement and contract performance.
• Oversee contract implementation and issue resolution for a portfolio of payor relationships.

Skills

PBM structures

Reimbursement negotiations

Formulary management

Contract modeling

Education

Bachelor’s degree

Job description

Sentara Health Plans is seeking a Manager, Managed Care Contracting to lead medical and pharmacy managed care contracting strategies for assigned payors. You will collaborate with clinical, pharmacy, and managed care leadership to optimize reimbursement, ensure contract performance, and align financial goals.

The role involves negotiating terms, analyzing contracts, and supporting day-to-day managed care operations, including patient access and claims adjudication.