Pharmacy Benefits Manager

Sentara Health; Virginia Beach (VA); Hybrid; USD 95,000 - 130,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Tuition Assistance

Job summary

Sentara Health in Virginia Beach seeks a Manager, Managed Care Contracting to lead contracting strategies for medical and pharmacy payors. You will collaborate with clinical and managed care leaders to optimize reimbursement, ensure contract performance, and align financial and operational objectives.

You will oversee payor relationships, contract implementation, issue resolution, and ongoing performance. This hybrid role requires a bachelor’s degree and 3+ years in managed care contracting and

Qualifications

• Bachelor's degree required.
• 3+ years of experience in managed care contracting required.
• 3+ years of experience in healthcare required.
• Experience in pharmacy managed care with PBM structures and reimbursement models.

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.
• Serve as primary liaison for payor relationships, overseeing contract implementation and issue resolution.
• Support data analysis and daily managed care operations including patient access and claims adjudication.

Skills

PBM knowledge

Pharmacy reimbursement

Contract negotiations

Formulary management

Utilization management

Drug pricing strategies

Financial analysis

Payor requirements

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 tooptimizereimbursement, ensure contract performance, and align financial and operationalobjectives. 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 andfacilitatescoordination 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 yearsofexperience in managed care contracting(Required)
• 3 yearsofexperiencein 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,utilizationmanagement, 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 ifestablished 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.