PBM Partnerships & Payer Relations Manager

• Serve as the main liaison for all PBM partners contractors TPAs and associated vendors.
• Manage onboarding implementations and ongoing communication to ensure alignment and strong operational performance.
• Oversee contract execution version control and escalation resolution with external partners.
• Proactively step in to assist with prior authorizations or operational duties as needed to ensure exceptional service continuity.
• Maintain a clear understanding of PBM reimbursement strategies plan designs MAC pricing and specialty pharmacy dynamics.
• Step in to assist with PAs or operations during high-volume periods or staffing gaps.

• Build new relationships with self-funded employers brokers benefits consultants and employer coalitions.
• Identify opportunities for employers to utilize the pharmacy as a preferred or direct-to-employer solution (specialty savings infusion savings carve-outs).
• Present pharmacy value propositions cost-savings models and service offerings to employer groups.
• Support the execution of direct-to-employer agreements and develop customized employer workflows.

• Drive expansion into new PBM networks payer groups and employer health plans.
• Research and pursue opportunities to improve reimbursement rates or negotiate favorable contract terms.
• Track market trends competitive pricing and plan changes influencing pharmacy performance.
• Strengthen ties with existing PBM and payer partners to secure long-term relationships.

• Troubleshoot operational issues adjudication errors reimbursement discrepancies and network constraints.
• Collaborate with internal teams (legal finance operations pharmacy) to ensure contractual accuracy and workflow alignment.
• Maintain oversight of contract renewals amendments compliance obligations and key dates.
• Support renegotiation efforts by preparing comparisons contract reviews and partner summaries.

• Track reimbursement patterns adjudication behaviors specialty margins and PBM performance metrics.
• Generate internal reporting to evaluate partnership effectiveness and financial outcomes.
• Identify opportunities to optimize pricing strategies improve patient access and enhance profitability.

• Cultivate strong trust-based relationships with PBM executives employer decision-makers consultants and industry partners.
• Represent the organization at meetings conferences and strategic discussions.
• Identify emerging opportunities for collaboration market expansion or product/service enhancement.

• Bachelors degree in Business Healthcare Administration Pharmacy or a related field.
• Experience working with PBMs payers networks benefits administrators or pharmacy operations.
• Strong communication negotiation and relationship-management skills.
• Ability to manage contracts escalations timelines and multi-stakeholder relationships.
• Strong analytical thinking problem-solving skills and organizational abilities.

• Prior experience working directly with PBMs TPAs or self-funded employer groups.
• Experience in specialty pharmacy infusion services or pharmacy network contracting.
• Working knowledge of claim adjudication reimbursement structures MAC lists spread pricing and DIR fee models.
• Experience building direct-to-employer pharmacy programs or benefit carve-out models.
• Familiarity with value-based pharmacy programs outcomes reporting and data-driven performance metrics.
• Strong understanding of healthcare contracting payer policies and benefits administration.
• Ability to interpret contract terms fee schedules and reimbursement methodologies.
• Experience presenting pharmacy solutions or savings programs to employers payers or consultants.
• Existing relationships with PBMs benefit brokers employer groups or industry partners is a major plus.

Required Experience:

Manager