Pharmacy Benefits Manager

Sentara Health; Virginia Beach (VA); Vor Ort; USD 110.000 - 140.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Paid time off

Parental & family leave

401k with employer match

Tuition assistance

CEU access

Pet insurance

Legal resources

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

PBM structures

Reimbursement negotiations

Formulary management

Contract modeling

Ausbildung

Bachelor’s degree

Jobbeschreibung

## Pharmacy Benefits ManagerApplyremote type: Hybridlocations: Virginia Beach, VAtime type: Full timeposted on: Posted Yesterdayjob requisition id: JR-104136**City/State**Virginia Beach, VA**Work Shift**First (Days)**Overview:**Manager, Managed Care ContractingThe 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)We are seeking demonstrated experience in pharmacy managed care, including:* 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 strategiesStrong financial acumen with experience in contract modeling and reimbursement analysisKnowledge of healthcare regulations, payor requirements, and value-based care arrangements preferred**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• Reimbursement for certifications and free access to complete CEUs and professional development•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.### About UsSentara 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!