Director, PBM Specialty Pharmacy Network Contracting

Navitus Health Solutions, LLC•,

1d•$142,128 - $177,660•Remote

About The Position

The Director, Specialty Pharmacy Network Contracting is responsible for leading the negotiation, execution, and ongoing management of specialty pharmacy network contracts across all provider segments. This role holds direct accountability for contract strategy, provider agreements, and the financial outcomes of negotiated specialty pharmacy reimbursement structures. The Director serves as the contracting authority for specialty pharmacy provider agreements, leading negotiations with national chains, specialty pharmacies, health system–affiliated providers, and limited distribution networks. This role ensures that contract terms are competitive, sustainable, and aligned with enterprise pricing strategy, regulatory requirements, manufacturer distribution models, and long-term network objectives. This role works closely with the Senior Director, Network Contracting to drive contracting strategy, establish negotiation priorities, and ensure alignment with enterprise network and financial objectives.

Requirements

Bachelor’s degree in Business, Finance, Economics, or Healthcare Administration, or related field, or equivalent work experience, required.
7+ years of progressive PBM, healthcare plan, pharmacy network, or equivalent experience required.
Demonstrated experience in provider contracting, contract strategy, or network governance required.
Strong understanding of pharmacy reimbursement and claims adjudication concepts required.
3+ years of leadership experience with a proven ability to develop high-performing teams and deliver tangible results in a professional services environment required.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.

Responsibilities

Lead negotiation of specialty pharmacy participation agreements across all provider segments, including national chains with specialty capabilities, independent specialty pharmacies, and health system–affiliated providers.
Own reimbursement structures, contract terms, and financial outcomes for specialty pharmacy agreements, including high-cost drug categories.
Establish negotiation strategies that balance market competitiveness, provider sustainability, and enterprise financial objectives within the specialty drug landscape.
Serve as the decision-maker for contract structure, rate positioning, and escalated negotiation decisions.
Approve contract exceptions and ensure alignment to broader specialty network and enterprise strategy.
Provide strategic leadership over specialty pharmacy participation agreements, network addenda, and contract standards, ensuring consistency with enterprise pricing, access, and compliance objectives.
Develop and maintain contracting playbooks, standards, and governance frameworks to support scalable and consistent negotiation practices.
Guide contract structure decisions to support evolving pricing strategies, regulatory changes, and market dynamics.
Recommend enhancements to contract language and structure to improve clarity, enforceability, and long-term sustainability.
Lead specialty provider engagement strategy to support successful contract negotiations, alignment to contract intent, and long-term network stability.
Serve as a senior point of contact for complex and strategic provider discussions, including reimbursement changes, contract interpretation, and structural alignment.
Maintain strong relationships with key pharmacy partners to support transparency, issue prevention, and alignment on contract expectations.
Drive resolution of high-impact or systemic provider issues, ensuring alignment to contract terms and enterprise objectives.
Ensure negotiated specialty contract terms are clearly defined and positioned for accurate implementation across systems and operations.
Partner with Network Operations and Network Implementation teams to support effective handoff, implementation, and validation of specialty contract terms.
Provide strategic guidance on contract interpretation to support claims configuration, specialty program execution, and network governance.
Support enterprise initiatives related to specialty network expansion, growth, and regulatory readiness.
Accountable for financial performance of specialty pharmacy network contracts, ensuring negotiated reimbursement terms align with enterprise pricing strategy and expected outcomes.
Partner with Network Operations and Network Performance teams to ensure contracted terms are operationalized and achieved through effective execution and monitoring.
Incorporate performance insights and market feedback into future negotiation strategies and contract design decisions.
Act as escalation point for complex, high-risk, or systemic specialty contract issues requiring higher-level leadership intervention.
Analyze provider disputes, reimbursement challenges, and operational friction to identify opportunities for contract and process improvement.
Drive initiatives to enhance contract clarity, reduce administrative burden, and improve provider alignment within the specialty network.
Provide leadership and direction to contract managers and/or senior contracting staff supporting specialty network providers.
Set expectations for negotiation discipline, contract quality, documentation, and escalation standards.
Foster a high-performing team environment focused on accountability, execution excellence, and adaptability within a rapidly evolving specialty landscape.