Pharmacy Benefits Manager

Sentara-9; Virginia Beach (VA); Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k with employer match

Paid Time Off and sick leave

Tuition assistance

Discretionary bonus eligibility

Job summary

Sentara Health seeks a Manager of Managed Care Contracting to lead medical and pharmacy contracting strategies for a payor portfolio, ensuring optimized reimbursement and contract performance. The role collaborates with clinical and managed care leaders to support day-to-day operations including patient access and claims adjudication.

The position requires a Bachelor's degree and at least three years in managed care contracting plus healthcare experience.

Qualifications

• Bachelor's degree required.
• 3 years of experience in managed care contracting required.
• 3 years of experience in healthcare required.
• Demonstrated experience in pharmacy managed care preferred.
• Understanding of PBM structures and reimbursement models (AWP, MAC, NADAC) preferred.

Responsibilities

• Lead medical and pharmacy managed care contracting strategies for assigned payors.
• Partner with clinical, pharmacy, and managed care leadership to optimize reimbursement and contract performance.
• Oversee contract implementation, issue resolution, and ongoing performance.
• Support data analysis and day-to-day managed care operations coordination.
• Contribute to patient access, claims adjudication, and care management processes.

Skills

PBM structures

Reimbursement models

Negotiation skills

Formulary management

Utilization management

Drug pricing strategies

Contract modeling

Regulatory knowledge

Payor requirements

Value-based care

Education

Bachelor's degree

Job description

City/StateVirginia Beach, VAWork ShiftFirst (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.EducationBachelor’s degree (Required)Experience3 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 agreementsKnowledge 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 preferredBenefits: Caring For Your Family and Your CareerMedical, Dental, Vision plansAdoption, Fertility and Surrogacy Reimbursement up to $10,000Paid Time Off and Sick LeavePaid Parental & Family Caregiver LeaveEmergency Backup CareLong-Term, Short-Term Disability, and Critical Illness plansLife Insurance401k/403B with Employer MatchTuition Assistance – $5,250/year and discounted educational opportunities through Guild EducationStudent Debt Pay Down – $10,000Reimbursement for certifications and free access to complete CEUs and professional developmentPet InsuranceLegal Resources PlanColleagues 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.