Managed Care & Pharmacy Contracting Lead

Sentara Health; United States; Hybrid; USD 112,000 - 173,000; Full time

Benefits offered by this job

Medical, dental, vision

401(k)/403(b) with company match

Paid time off

Education assistance

Bonus opportunities

Job summary

Sentara Health in Virginia Beach seeks a Manager of Managed Care Contracting to lead contracting strategies for medical and pharmacy payors. You will partner with clinical, pharmacy, and managed care leaders to optimize reimbursement, ensure contract performance, and align financial goals.

The role covers contract implementation, issue resolution, and ongoing performance monitoring. The position is hybrid, with two days remote and three days on site at Sentara Park.

Qualifications

• 3 years of experience in managed care contracting.
• 3 years of experience in healthcare.
• Understanding of PBM structures and reimbursement models (e.g., AWP, MAC, NADAC).
• 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

• Develop and lead medical and pharmacy managed care contracting strategies for assigned payors.
• Serve as primary liaison for payor relationships, overseeing contract implementation and issue resolution.
• Oversee day-to-day managed care operations, including patient access and claims adjudication.
• Collaborate with clinical, pharmacy, and managed care leadership to optimize reimbursement and performance.

Skills

Managed care contracting

PBM knowledge

Reimbursement analysis

Formulary management

Financial acumen

Regulatory knowledge

Education

Bachelor's degree

Job description

Sentara Health in Virginia Beach seeks a Manager of Managed Care Contracting to lead contracting strategies for medical and pharmacy payors. You will partner with clinical, pharmacy, and managed care leaders to optimize reimbursement, ensure contract performance, and align financial goals.

The role covers contract implementation, issue resolution, and ongoing performance monitoring. The position is hybrid, with two days remote and three days on site at Sentara Park.