PBM Partnerships & Payer Relations Manager

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.

We are seeking a proactive, relationship-driven PBM Partnerships & 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.

• 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&D, etc.

• 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,…