Pharmacy Benefits Manager

Sentara-9; Virginia Beach (VA); Hybrid; USD 112,000 - 173,000; Full time

Benefits offered by this job

Medical, Dental & Vision plans

401k with employer match

Tuition assistance

Paid time off & sick leave

Bonus opportunities

Job summary

Sentara Health in Virginia Beach is seeking a Manager, Managed Care Contracting to lead contracting strategies with third-party payors. You will partner with clinical, pharmacy and managed care leadership to optimize reimbursement and contract performance.

Hybrid role with two days remote and three on site at Sentara Park. Richmond opportunity exists for residents to work similar schedule in Richmond.

Qualifications

• Bachelor’s degree required.
• At least 3 years in managed care contracting.
• Experience in healthcare (3+ years) required.
• Demonstrated PBM experience, reimbursement models, and formulary management preferred.
• Strong financial acumen and contract modeling experience.

Responsibilities

• Lead managed care contracting strategies and activities for assigned third-party payors.
• Serve as primary liaison for payor relationships and oversee contract implementation.
• Support data analysis and day-to-day managed care operations including patient access and claims adjudication.

Skills

PBM knowledge

Pharmacy reimbursement

Contract modeling

Financial acumen

Payor relations

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 preferredWe 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.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.