Remote PBM Director: Payer Contracts & Growth

CSI Pharmacy, LLC; Washington (District of Columbia); Hybrid; USD 150,000 - 180,000; Full time

Job summary

CSI Pharmacy, LLC is seeking a Director Pharmacy Benefit Manager to lead PBM strategy, contract negotiations, and payer relations for national accounts. This role focuses on securing favorable terms, coordinating with sales, implementation, and operations, and driving revenue growth in specialty pharmacy.

The ideal candidate understands Medicare/Medicaid, payer reimbursement, and revenue cycle operations, with 5+ years in PBM leadership. Travel ~25-30% and remote-friendly schedule.

Qualifications

• Bachelor’s degree 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.

Responsibilities

• Lead the growth and strategic development of the Company's PBM business, including client acquisition, implementation, retention, and expansion initiatives.
• Lead the negotiation, implementation, and ongoing administration of managed care across the assigned region.
• Develop and maintain processes to ensure timely dissemination of contract terms, reimbursement methodologies, operational requirements, and payer updates to key stakeholders.
• Manage all phases of the contract lifecycle, including evaluation, negotiation, approval, implementation, monitoring, renewal, amendment, and termination activities.
• Analyze contract performance and reimbursement trends to identify opportunities for revenue optimization and operational improvement.
• Maintain a comprehensive understanding of Medicare, Medicaid, commercial payer reimbursement methodologies, pharmacy benefit design, and provider payment structures.
• Serve as the primary point of contact for payer relations and contract performance management.
• Collaborate with leadership, revenue cycle, operations, billing, pharmacy, compliance, and credentialing teams to ensure successful contract implementation and ongoing compliance.
• Develop and strengthen relationships with medical and pharmacy benefit plans to secure competitive reimbursement rates and favorable contract language.
• Oversee payer credentialing and recredentialing activities to ensure uninterrupted network participation.
• Assist operational teams with payer-related issues, including prior authorizations, eligibility verification, referrals, enrollment requirements, billing concerns, and payer education initiatives.
• Monitor payer compliance with contract terms and address reimbursement, operational, or performance issues as they arise.
• Identify market opportunities and support growth initiatives through strategic payer engagement and business development activities.
• Regularly communicate payer trends, reimbursement changes, regulatory developments, and network opportunities to leadership.
• Represent the company professionally in all interactions with payers, clients, providers, and industry stakeholders.
• Maintain effective working relationships with colleagues across all departments.
• Adhere to all company policies, compliance requirements, regulatory standards, and applicable federal and state laws.
• Perform other duties and responsibilities as assigned.

Education

Bachelor’s Degree

Job description

CSI Pharmacy, LLC is seeking a Director Pharmacy Benefit Manager to lead PBM strategy, contract negotiations, and payer relations for national accounts. This role focuses on securing favorable terms, coordinating with sales, implementation, and operations, and driving revenue growth in specialty pharmacy.

The ideal candidate understands Medicare/Medicaid, payer reimbursement, and revenue cycle operations, with 5+ years in PBM leadership. Travel ~25-30% and remote-friendly schedule.