Manager Pharmacy Credentialing Payor Contracting, Pharmacy Administration

Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors.

What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients’ shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we’re all in.

Description:

Bachelors degree in Accounting, Business or Healthcare Administration or 10 years in Healthcare regulatory and certifications experience. Master’s or CPA preferred. Also 8-10 years experience in a pharmacy contracting, credentialling and manufacturer direct access environment. Knowledge of contracting with pharmacy payors, CMS and Medicaid regulations, strategic planning, financial analysis, marketing, reimbursement, and related activities. A proven leader with excellent negotiation skills.

Bachelors degree in Accounting, Business or Healthcare Administration or 10 years in Healthcare regulatory and certifications experience. Master’s or CPA preferred. Also 8-10 years experience in a pharmacy contracting, credentialling and manufacturer direct access environment. Knowledge of contracting with pharmacy payors, CMS and Medicaid regulations, strategic planning, financial analysis, marketing, reimbursement, and related activities. A proven leader with excellent negotiation skills.

Responsible for overseeing payor contract negotiations for BHSF Pharmacies, Pharmaceutical manufacturers credentialling, clinically integrated pharmacy networks and ensure regulatory compliance with licensure and regulatory compliance such as CMS (Federal), Medicaid. Responsible for review of contract language, financial analysis and modeling, coordinating efforts with outside legal counsel, overseeing the actual negotiations with pharmacy benefit managers (PBM). Also responsible for the implementation and oversight of existing payor agreements and the ongoing strategic analysis of all payor/manufacture relationships. Responsible for addressing pharmacy benefit payor operational issues including administration of the agreements, underpayment support, credentialing support, network development and payor interactions. Also responsible for managing all aspects of pharmacy licensure, certification, and leading the pharmacy department’s strategic initiatives related to external business development, pharmacy trade relations within the health system

Qualifications:

Bachelor's degree in accounting, Business or Healthcare Administration or 10 years in healthcare regulatory and certifications experience. Master’s or CPA preferred. Also 8-10 years' experience in a pharmacy contracting, credentialling and manufacturer direct access environment. Knowledge of contracting with pharmacy payors, CMS and Medicaid regulations, strategic planning, financial analysis, marketing, reimbursement, and related activities. A proven leader with excellent negotiation skills.

8 years of experience required.

EOE, including disability/vets