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Pbm Contracting Jobs (NOW HIRING)

Gifthealth

Director of PBM Contracting

Columbus, OH · On-site

$150K - $200K/yr

The Director of PBM Contracting will build and lead a small team, work cross-functionally with pharmacy operations, finance, compliance, and technology, and ensure our PBM relationships are both ...

giftHEALTH Inc

Director of PBM Contracting

Columbus, OH · On-site

$150K - $200K/yr

The Director of PBM Contracting will build and lead a small team, work cross-functionally with pharmacy operations, finance, compliance, and technology, and ensure our PBM relationships are both ...

Gifthealth Inc

Director of PBM Contracting

Columbus, OH · On-site

$150K - $200K/yr

The Director of PBM Contracting will build and lead a small team, work cross-functionally with pharmacy operations, finance, compliance, and technology, and ensure our PBM relationships are both ...

Amerita

Director of Payer Contracts / Remote

Englewood, CO · Remote

$165K - $190K/yr

Our Company Amerita Overview Key responsibilities include but are not limited to the management of the Payer Contract Administration and Payer Implementation functions as well as PBM contracting and ...

Amerita

Director of Payer Contracts / Remote

Englewood, CO · On-site +1

$165K/yr

Our Company Amerita Overview Key responsibilities include but are not limited to the management of the Payer Contract Administration and Payer Implementation functions as well as PBM contracting and ...

Truveris

Customer Success Director

Wilmington, DE · Remote

This role is best suited for someone who brings deep, hands-on expertise in PBM contracting and enjoys operating as a consultative, strategic advisor to senior stakeholders. You will guide clients ...

Truveris

Customer Success Director

Wilmington, DE · On-site +1

$120K - $150K/yr

This role is best suited for someone who brings deep, hands-on expertise in PBM contracting and enjoys operating as a consultative, strategic advisor to senior stakeholders. You will guide clients ...

Prime Therapeutics

Legal Counsel

Home, WA

$124K - $211K/yr

Job Posting Title Legal Counsel The Legal Counsel (PBM Contracting) provides tactical legal advice and support to internal clients, typically at the Director or Vice President level. Responsibilities

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Prime Therapeutics LLC

Legal Counsel

Home, WA

$124K - $211K/yr

Job Posting Title Legal Counsel The Legal Counsel (PBM Contracting) provides tactical legal advice and support to internal clients, typically at the Director or Vice President level. Responsibilities

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Pbm Contracting information

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How much do pbm contracting jobs pay per hour?

As of Jun 29, 2026, the average hourly pay for pbm contracting in the United States is $24.19, according to ZipRecruiter salary data. Most workers in this role earn between $19.95 and $27.40 per hour, depending on experience, location, and employer.

What is the difference between Pbm Contracting vs Pbm Electrician?

AspectPbm ContractingPbm Electrician
CredentialsGeneral contracting license, safety certificationsElectrical license, journeyman or master electrician certification
Work EnvironmentConstruction sites, project managementElectrical installations, maintenance, troubleshooting
Employer & IndustryConstruction companies, general contracting firmsElectrical contractors, industrial and commercial facilities

While Pbm Contracting oversees entire construction projects, Pbm Electrician specializes in electrical systems installation and repair. Both roles require safety certifications, but Pbm Electrician focuses specifically on electrical work, often within the broader scope of Pbm Contracting projects.

What is PBM contracting?

PBM contracting refers to the agreements made between Pharmacy Benefit Managers (PBMs) and other entities, such as pharmacies, drug manufacturers, or health plans. These contracts determine how prescription drug benefits are managed, including drug pricing, reimbursement rates, formulary management, and rebate arrangements. PBM contracting plays a crucial role in controlling drug costs and ensuring access to medications for patients. Understanding these contracts is important for healthcare providers, pharmacies, and insurers to optimize drug benefit management and costs.

What are some common challenges faced by professionals working in PBM Contracting, and how can they be addressed?

Professionals in PBM (Pharmacy Benefit Management) Contracting often encounter challenges such as navigating complex negotiations with pharmaceutical manufacturers and health plan clients, staying current with evolving regulations, and balancing cost containment with maintaining access to quality medications. Success in this role requires strong analytical and communication skills, as well as a collaborative approach to working with legal, clinical, and sales teams. Staying proactive in monitoring industry trends and participating in ongoing training can help address these challenges and ensure effective contract management.

What are the key skills and qualifications needed to thrive as a PBM Contracting Specialist, and why are they important?

To thrive as a PBM (Pharmacy Benefit Manager) Contracting Specialist, you need a strong background in contract negotiation, healthcare regulations, and pharmacy benefit management, typically supported by a degree in business, pharmacy, or healthcare administration. Familiarity with contract management software, PBM platforms, and knowledge of Medicare/Medicaid regulations is essential. Exceptional attention to detail, strong communication, and analytical thinking are crucial soft skills for success in this role. These skills ensure contracts are negotiated effectively, compliance is maintained, and mutually beneficial relationships are fostered between PBMs and clients.
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What states have the most Pbm Contracting jobs? States with the most job openings for Pbm Contracting jobs include:
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Pbm Contracting jobs near you
Director of PBM Contracting

Director of PBM Contracting

Gifthealth

Columbus, OH • On-site

$150K - $200K/yr

Full-time

Posted 17 days ago

Job description

Position Summary
We are seeking a Director of PBM Contracting to join our Gifthealth team. Reporting to the Chief Legal Officer, this role serves as Gifthealth's primary point of contact with all PBM partners and owns the full PBM contracting lifecycle, including negotiation of new and renewal agreements, reimbursement integrity and rate validation, compliance monitoring, and audit response. This position plays a key role in Payer Relations / Revenue Operations, ensuring alignment with organizational goals, operational excellence, and compliance standards.
Gifthealth's direct-to-patient model operates across multiple payer networks, and the terms we hold with our PBM partners directly shape our reimbursement rates, network eligibility, and compliance posture. The Director of PBM Contracting will build and lead a small team, work cross-functionally with pharmacy operations, finance, compliance, and technology, and ensure our PBM relationships are both commercially optimized and operationally sound.
Key Responsibilities
  • PBM Contract Negotiation: Lead all PBM contract negotiations on behalf of Gifthealth, including new network agreements, renewals, amendments, and specialty contract structures. Develop negotiation strategies that optimize reimbursement rates, MAC appeals rights, network access terms, dispensing fee structures, and audit provisions. Own the full contract lifecycle from initial terms through execution and ongoing performance monitoring.
  • Primary PBM Relationship Ownership: Serve as Gifthealth's named point of contact with all PBM partners, including commercial, Medicare Part D, Medicaid managed care, and specialty PBMs. Build and maintain active working relationships with PBM contracting, network, and compliance teams. Represent Gifthealth professionally and authoritatively in every PBM interaction.
  • Reimbursement Integrity and Rate Validation: Own the process for validating that Gifthealth is receiving accurate reimbursements consistent with contracted terms across all PBM networks. Monitor adjudication data for rate anomalies, underpayments, and clawback patterns. Coordinate with pharmacy operations and finance to resolve discrepancies and recover owed reimbursements.
  • PBM Compliance Management: Ensure Gifthealth's operations remain in continuous compliance with PBM network agreements, provider manuals, credentialing requirements, and performance standards. Monitor for contract amendments or policy updates from PBM partners and translate requirements into internal operational actions with appropriate lead time.
  • Audit Support and Response: Serve as Gifthealth's lead for PBM-initiated audits, coordinating evidence collection, preparing response documentation, communicating with PBM audit teams, and managing remediation. Work proactively to reduce audit risk through internal controls, documentation standards, and pre-audit readiness reviews.
  • Team Leadership: Build and lead a team of PBM Contracting Specialists and Analysts. Assign and manage workload across the PBM portfolio, develop team expertise in contract analysis and payer relations, and create internal processes and tools that scale with Gifthealth's growing network of PBM relationships.
  • Continuing Education and Market Intelligence: Maintain an active continuing education posture across PBM contracting, reimbursement policy, pharmacy network legislation, and CMS guidance. Attend industry conferences, participate in pharmacy association forums, and leverage PBM partner relationships to stay ahead of changes that affect Gifthealth's contract terms or compliance obligations.
  • Cross-Functional Collaboration: Partner with pharmacy operations on network credentialing and compliance execution; with finance on reimbursement forecasting and per-dispense economics modeling; with technology on claims and adjudication data infrastructure; and with compliance and legal on contract review and regulatory interpretation.
Qualifications
  • Education: Bachelor's degree or equivalent experience required; degree in healthcare administration, pharmacy, business, or a related field preferred.
  • Experience: 8+ years of experience in PBM contracting, payer relations, pharmacy reimbursement, or pharmacy network management; direct, hands-on experience negotiating PBM contracts; 3+ years in a role with direct PBM negotiation accountability; experience managing PBM audits through resolution; experience working in or on behalf of a specialty pharmacy or mail order pharmacy operation.
  • Licensure/Certification: Not required. Pharmacist (RPh or PharmD) licensure or Certified Pharmacy Technician (CPhT) with deep payer-side experience preferred. Active participation in pharmacy association PBM forums or contracting continuing education preferred.
  • Skills (Required): Demonstrated familiarity with PBM contract economics including MAC pricing, AWP discount schedules, dispensing fees, network access terms, and audit provisions; strong analytical skills and ability to work with adjudication data to identify reimbursement discrepancies and model contract financial impact; track record of building and maintaining productive relationships with PBM contracting and network teams; ability to translate payer obligations into operational priorities and hold cross-functional teams accountable.
  • Skills (Preferred): Experience in a DTP pharmacy model or with manufacturer-sponsored patient access programs; prior experience at or contracting with major PBMs (ESI/Evernorth, CVS Caremark, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics); familiarity with PSAO contracting structures; working knowledge of CMS Part D pharmacy network regulations and state PBM legislation; experience managing limited distribution network (LDN) contracts or specialty hub-to-pharmacy contracting arrangements.
Desired Attributes
  • Has sat across the table from PBM contracting teams and pushed back on terms that eroded pharmacy economics - not intimidated by PBM complexity, and uses it to Gifthealth's advantage.
  • Maintains productive PBM relationships even when actively negotiating or disputing terms - professionally assertive, not adversarial.
  • Builds internal compliance monitoring systems that catch issues before they become audit findings - proactive, not reactive.
  • Distills complex PBM economics into clear summaries for executive audiences and is comfortable presenting reimbursement performance and contract negotiation strategy at the COO or C-suite level.
  • Builder mentality - excited to put in place the contracts, relationships, and compliance infrastructure that will define Gifthealth's payer position for years ahead.
Work Environment
  • Location: Remote
  • Schedule: Full-time. May require travel for industry conferences, PBM partner meetings, and association events.
  • Regular collaboration with pharmacy operations, finance, compliance, technology, and legal. Regular external engagement with PBM contracting, network, and audit teams across all active PBM relationships.
Key Essential Functions
  • Must be able to perform sedentary office work for extended periods, including sustained use of a computer and telephone.
  • Must be able to travel for industry conferences, PBM partner meetings, and professional association events.
  • Must be able to communicate effectively verbally and in writing across multiple organizational levels including the C-suite and with external PBM partners.
  • Must be able to manage multiple concurrent PBM contracts, compliance obligations, audit responses, and team responsibilities simultaneously.
Employment Classification
Status: Full-time
FLSA: Exempt
Equal Employment Opportunity (EEO) Statement
Gifthealth is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, veteran status, or any other legally protected status. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Disclaimer
This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, or skills required of personnel. Gifthealth reserves the right to modify job duties or descriptions at any time.
Salary Description
$150,000-$200,000

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