Pharmacy Benefits Manager

sentara; Virginia Beach (VA); Hybrid; USD 112,000 - 173,000; Full time

Benefits offered by this job

Medical plans

Dental plans

Vision plans

Paid time off

Parental leave

Family leave

Emergency backup care

Disability plans

Life insurance

401k/403b with employer match

Tuition assistance

Student debt pay down

Pet insurance

Legal resources

Annual bonus

Job summary

Sentara Health in Virginia Beach, VA, is seeking a Manager of Managed Care Contracting. This hybrid role involves leading contracting strategies for medical and pharmacy payors, coordinating with clinical and financial leaders to optimize reimbursement and contract performance.

The role requires a Bachelor's degree and at least 3 years of experience in managed care contracting and healthcare, with PBM familiarity and strong negotiation skills.

Qualifications

• Bachelor's degree required.
• 3 years of experience in managed care contracting.
• 3 years of experience in healthcare.
• Knowledge of PBM structures, reimbursement models, and drug pricing strategies.

Responsibilities

• Lead medical and pharmacy managed care contracting strategies and activities for assigned payors.
• Serve as primary liaison for a portfolio of payor relationships and oversee contract implementation.
• Support data analysis and coordination of day-to-day managed care operations (patient access, claims adjudication, care management).
• Collaborate with clinical, pharmacy, and managed care leadership to optimize reimbursement and contract performance.

Skills

Managed care contracting

Healthcare industry experience

PBM knowledge

Contract negotiation

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)

We are seeking d emonstrated 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 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, overtime, 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.

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.

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.