The Director of Provider Relations is responsible for the strategic management and operational oversight of pharmacy network relationships. This role drives network performance, credentialing integrity, and provider engagement while advancing network strategy, cost efficiency, and service excellence. The Director partners cross-functionally to ensure pharmacy network alignment with organizational objectives, regulatory requirements, and client commitments.
Role and Responsibilities- Serve as relationship owner for key pharmacy partners, including retail, specialty, and PSAO networks.
- Lead provider engagement strategies to strengthen collaboration, resolve escalations, and improve performance.
- Oversee end-to-end credentialing lifecycle for participating pharmacies, including onboarding, recredentialing, and ongoing monitoring.
- Ensure compliance with internal policies and regulatory standards, including licensure, DEA, liability coverage, and URAC standards.
- Establish and monitor key network performance metrics, including access, disruption, reimbursement, provider satisfaction, credentialing progress, and contract status.
- Analyze network trends and identify opportunities to improve cost efficiency, quality, and member experience.
- Assist in developing and executing pharmacy network strategies and operational execution aligned to growth, cost, and client objectives.
- Optimize provider relations processes, tools, and workflows to improve scalability, service levels, issue resolution, and audit readiness.
- Lead cross-functional coordination with pharmacy contracting, pricing, compliance, operations, IT, and client teams to improve provider experience and internal efficiency.
- Support client-facing engagements and ensure delivery against contractual commitments.
Qualifications and Education Requirements- 5-6+ years of experience in PBM, pharmacy network management, or healthcare provider relations.
- Deep understanding of pharmacy credentialing, contracting, and network operations.
- Strong analytical and strategic thinking capabilities.
- Proven ability to manage provider relationships and complex negotiations.
- Executive-level communication skills with internal and external stakeholders.
Preferences- Experience leading provider relations or network operations teams in a PBM, managed care, or pharmacy services environment.
- Demonstrated success building scalable provider operations, improving network performance, and balancing cost optimization with provider satisfaction and member access.
Physical RequirementsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office setting which involves utilizing a computer, mouse, keyboard, and occasionally operates other standard office equipment such as a printer, copier, and phone. Minimal travel may be required.
Salary:
$118,876-$139,307
