Pharmacy Benefits Manager

Sentara Health; Virginia Beach (VA); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Adoption, Fertility and Surrogacy Reim

Paid Time Off and Sick Leave

Paid Parental & Family Caregiver Leave

Emergency Backup Care

Long-Term Disability & Life Insurance

401k/403B with Employer Match

Tuition Assistance – $5,250/year

Student Debt Pay Down – $10,000

CEU access

Pet Insurance

Job summary

Sentara Health in Virginia Beach, VA is seeking a Manager, Managed Care to lead contracting strategies for medical and pharmacy payors. The role partners with clinical, pharmacy, and managed care leadership to optimize reimbursement, ensure contract performance, and align financial objectives.

The position is hybrid, located at 1300 Sentara Park, Virginia Beach, with two days remote and three days on site. Richmond residency option may apply with a shared schedule.

Qualifications

• Bachelor’s degree is required.
• Minimum 3 years of experience in managed care contracting.
• Experience in healthcare is required; pharmacy managed care experience is preferred.

Responsibilities

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

Skills

Managed care contracting

Pharmacy PBM knowledge

Reimbursement analysis

Contract negotiation

Financial acumen

Education

Bachelor's degree

Job description

City/State

Virginia Beach, VA

Work Shift

First (Days)

Overview

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 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 strategies

Strong financial acumen with experience in contract modeling and reimbursement analysis

Knowledge 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.