Remote Director, PBM Strategy & Payer Relations

CSI Pharmacy; Nash (TX); On-site; USD 150,000 - 180,000; Full time

Job summary

CSI Pharmacy is seeking a Director Pharmacy Benefit Manager to lead strategic PBM initiatives on a nationwide basis. The role focuses on negotiations, implementation, and ongoing management of payer contracts, while strengthening relationships across health plans, employers, and providers.

The ideal candidate has deep expertise in specialty pharmacy reimbursement, payer contracting, and the Medicare/Medicaid landscape, with a track record of driving revenue growth.

Qualifications

• Bachelor's degree preferred or equivalent experience.
• Minimum of five (5) years of progressive experience in PBM operations, PBM sales, pharmacy contracting, managed care contracting, or specialty pharmacy leadership.
• Demonstrated success negotiating PBM, specialty pharmacy, and managed care agreements.
• Preferred experience in managing, analyzing, and reporting denials and appeals.

Responsibilities

• Lead growth and strategic development of the PBM business with clients.
• Negotiate, implement, and administer managed care across the region.
• Develop processes for timely contract terms, reimbursement methodologies, and payer updates.
• Manage all phases of the contract lifecycle: evaluation, negotiation, implementation, renewal.
• Analyze performance and reimbursement trends for revenue opportunities.
• Understand Medicare, Medicaid, commercial payer reimbursement and provider payment structures.
• Serve as primary contact for payer relations and contract performance.
• Collaborate with leadership and departments to ensure compliance.
• Develop relationships with payers to secure favorable rates and terms.
• Oversee payer credentialing and recredentialing for network participation.

Skills

PBM operations

Pharmacy contracting

Managed care contracting

Specialty pharmacy

Leadership

Education

Bachelor's degree or equivalent experience

Job description

CSI Pharmacy is seeking a Director Pharmacy Benefit Manager to lead strategic PBM initiatives on a nationwide basis. The role focuses on negotiations, implementation, and ongoing management of payer contracts, while strengthening relationships across health plans, employers, and providers.

The ideal candidate has deep expertise in specialty pharmacy reimbursement, payer contracting, and the Medicare/Medicaid landscape, with a track record of driving revenue growth.