Pharmacy Benefits Manager

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

City/State Virginia Beach, VA Work Shift First (Days)

Overview: Manager, Managed Care Contracting

The Manager, Managed Care leads medical and pharmacy managed care contracting strategies and activities for assigned third-party payors, supporting Sentara Healthcare provider divisions. This role partners with clinical, pharmacy, and managed care leadership to optimize reimbursement, ensure contract performance, and align financial and operational objectives. The Manager, Managed Care serves as the primary liaison for a portfolio of payor relationships, overseeing contract implementation, issue resolution, and ongoing performance. This role supports data analysis and facilitates coordination of day-to-day managed care operations, including patient access, claims adjudication, and care management.

Hybrid position at 1300 Sentara Park, Virginia Beach, Virginia --two days remote and three days on site at Sentara Park. There is an opportunity for Richmond (Virginia) residents to work same schedule at Sentara Health Plan in Richmond. Required to work each Wednesday at Sentara Park, Virginia Beach.

Education Bachelor's degree (Required)

• Experience 3 years of experience in managed care contracting (Required)
• 3 years of experience in healthcare (Required)
• Understanding of pharmacy benefit management (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
• Knowledge of healthcare regulations, payor requirements, and value-based care arrangements preferred

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $112,049.60 - $172,515.20 annually. Additional compensation may be available for this role, such as shift differentials, standby/on-call pay, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually.

Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; 401(k)/403(b) with employer match; paid time off (vacation, sick time, and holidays); paid parental and military leave; educational assistance or student loan repayment; and voluntary benefits.

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!