Sr. Manager, PBM Network Contracting

JOB REQUIREMENTS: Summary This role is responsible for managing andoptimizing relationships with Pharmacy Benefit Managers (PBMs) on behalfof our PSAO network, with a focus on contract execution, networkadministration, and dispute resolution. The Account Manager plays a keyrole in overseeing PBM network contracting, reconciliation analysis, andcoordinating with internal legal teams to resolve contract andreimbursement disputes. Additional responsibilities include trackingcredential status across the PSAO network, facilitating resolutions tonetwork rejections, and ensuring compliance with all contractualobligations. This position requires deep knowledge of PBM operations,exceptional attention to detail, and the ability to communicateeffectively with both internal stakeholders and external partners.Essential Duties and Responsibilities This list of duties andresponsibilities is not all inclusive and may be expanded to includeother duties and responsibilities as management may deem necessary fromtime to time. Manage and maintain relationships with PBMs, ensuringclear communication and swift resolution of issues related to networkparticipation, claims processing, and formulary adherence.Review andinterpret PBM contracts to identify risks, assess financial impact,ensure compliance with reimbursement terms, and support negotiationstrategy. Review existing contracts for deviations from templatelanguage; document terms in a database and maintain template comparisoncharts, defined parameters, and a matrix of provisiondeviations.Facilitate resolution of claim rejections, terminations, andother network access issues by coordinating directly with PBMs andimpacted pharmacies. Lead contract negotiation discussions with PBMrepresentatives to secure favorable terms for the PSAO network,including reimbursement rates, operational feasibility, reconciliationterms, and credentialing requirements.Collaborate with Legal to monitorCMS guidance and applicable state law provisions impacting PBMs andpharmacy benefits.Collaborate with the Legal team to identify andmitigate compliance risk areas associated with PBM pharmacy/providermanuals.Collaborate with Analytics team to Conduct detailedreconciliation analyses to identify underpayments, overpayments, andadjudication discrepancies; collaborate with PBMs and internal teams toresolve payment variances.Lead the NCPDP related onboarding process fornew PSAO clients, ensuring a smooth and efficient transition bycollaborating with internal teams and aligning with client expectations.Manage existing PBM contracts to ensure compliance by all parties;partner with internal legal counsel to support resolution of contractualdisputes and reimbursement conflicts with PBMs.Maintain detailed recordsof PBM interactions, contracts, reimbursement terms, and issueresolutions in platforms such as Salesforce and . Supportleadership with development and auditing of internal department policiesand procedures.Adhere to company policies and procedures and maintainstrict confidentiality of sensitive business and financial data.Performother duties as requested or required.Qualifications To perform this jobsuccessfully, an individual must be able to perform each essential dutysatisfactorily. The requirements listed below are representative of theknowledge, skill, and/or ability required. Reasonable accommodations maybe made to enable individuals with disabilities to perform the essentialfunctions. At least two years' prior experience in a client-facing orvendor facing role such as sales or account management, preferably in ahealthcare company.Bachelor's degree or equivalent stronglypreferred.Well-organized and detailed with the ability to communicate inan appropriate and timely manner.Ability to write and interpretcorrespondence, reporting and analytics.Ability to speak effectively toclients in person and o er the phone with high level of energy,attentiveness, honesty and overall sociability.Preferable experience inthe pharmacy or pharmacy benefit management industry. Physical DemandsThe physical demands described here are representative of those thatmust be met by an employee to successfully perform the essentialfunctions of this job. Reasonable accommodations may be made to enableindividuals with disabilities to perform the essential functions. (Thephrases

Created: 2026-03-23