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 ...
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 ...
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 ...
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 ...
Senior Analyst, Rebate and Audit - SMC
Three Rivers, MI · Remote
$88K - $110K/yr
Summary Synergie Medication Collective is a new medication contracting organization founded by a ... Knowledge of PBM and/or health care industry * Medical Pharmacy rebate knowledge Preferred ...
New
Senior Analyst, Rebate and Audit - SMC
Three Rivers, MI · Remote
$88K - $110K/yr
Summary Synergie Medication Collective is a new medication contracting organization founded by a ... Knowledge of PBM and/or health care industry * Medical Pharmacy rebate knowledge Preferred ...
New
Pbm Contracting information
What is the difference between Pbm Contracting vs Pbm Electrician?
| Aspect | Pbm Contracting | Pbm Electrician |
|---|---|---|
| Credentials | General contracting license, safety certifications | Electrical license, journeyman or master electrician certification |
| Work Environment | Construction sites, project management | Electrical installations, maintenance, troubleshooting |
| Employer & Industry | Construction companies, general contracting firms | Electrical 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.
Which job is best for a 40 year old woman?
For a 40-year-old woman considering a career, roles such as administrative assistant, customer service representative, or project coordinator can be suitable, as they often require strong communication and organizational skills. These jobs typically offer flexible schedules and do not require extensive physical demands or rapid technological adaptation, making them accessible options at this age.
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.
What are popular job titles related to Pbm Contracting jobs in Michigan? For Pbm Contracting jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Pbm Contracting jobs in Michigan look for? The top searched job categories for Pbm Contracting jobs in Michigan are:
What cities in Michigan are hiring for Pbm Contracting jobs? Cities in Michigan with the most Pbm Contracting job openings:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 28 days ago
Insight Enterprises rating
8.6
Based on 18 frontline employees who took The Breakroom Quiz
26th of 204 rated it services
Job description
Insight Health System is a physician-led organization focused on advancing excellence in healthcare and community well-being. Our expertise is in transforming distressed hospitals into stable, patient-centric care that is second to none. With a track record for innovation in healthcare, research and development, Insight Health System provides the communities we serve with world-class healthcare services at the forefront of medical technology. Our network currently includes a portfolio of entities encompassing six acute care hospitals (three of which are nonprofit), six surgery centers, 28 clinics, 580 physicians, 10 unions, and 4,200 employees. Collectively, Insight Health System hospitals provide nearly 100,000 patient days annually.
Position Overview
We are seeking a proactive, relationship-driven PBM Partnerships amp; Payer Relations Manager to serve as the primary point of contact for Pharmacy Benefit Managers (PBMs), third-party administrators (TPAs), brokers, and self-funded employer groups. This role is responsible for building new partnerships, strengthening existing relationships, supporting contract execution, ensuring operational accuracy, and driving network growth across all payer and PBM channels. The ideal candidate excels at communication, problem-solving, and business development within the pharmacy or healthcare benefits ecosystem.
We are seeking a proactive, relationship-driven PBM Partnerships amp; Payer Relations Manager to serve as the primary point of contact for Pharmacy Benefit Managers (PBMs), third-party administrators (TPAs), brokers, and self-funded employer groups. This role is responsible for building new partnerships, strengthening existing relationships, supporting contract execution, ensuring operational accuracy, and driving network growth across all payer and PBM channels. The ideal candidate excels at communication, problem-solving, and business development within the pharmacy or healthcare benefits ecosystem.
Benefits:
- Comprehensive health, dental, and vision insurance
- Paid time off: vacation, holidays, and sick leave
- 401(k) with employer match (immediate vesting; eligibility begins after 3 months)
- Employer - paid short - and long - term disability, basic life insurance
- Voluntary coverages: accident, critical illness, hospital indemnity, AD amp;D, etc.
Key Responsibilities:
PBM Partnership Management
- 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.
Self-Funded Employer Network Development
- 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.
Payer amp; Network Growth
- 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.
Operational amp; Contract Coordination
- 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.
Performance Monitoring amp; Reporting
- 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.
Relationship Building amp; Strategic Development
- 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.
Required Qualifications
- Bachelor’s 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.
Preferred Qualifications
- 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.
Insight is an equal opportunity employer and values workplace diversity!
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