As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position is responsible for the development of payer and provider contractual and business relationships designed to successfully position University of Utah Health Hospitals and Clinics in local, regional and national markets. This position negotiates individual patient agreements as well as complex local and national clinical contracts on behalf of University of Utah Health Hospitals and Clinics. This position has no responsibility for providing care to patients.

 

Specifically, the Clinical Contract Manager within Pharmacy Department is responsible for managing and optimizing pharmacy benefit agreements with Pharmacy Benefit Managers (PBMs), including University of Utah Health Plans, third-party administrators, and other vendors. This position also supports Payer Relation’s efforts to identify and respond to pharmaceutical related issues as they arise in medical benefit claim instances. Overall, this role ensures that contracts align with organizational goals for cost containment, compliance, and quality of care.

 

• Leads the review, analysis, and management of pharmacy and medical benefit contracts, including PBM agreements, specialty PSAO opportunities, payer inquiries, and risk assessment to ensure compliance and alignment with organizational goals.

• Negotiates with PBMs, payers, and vendors to secure favorable pricing, rebates, service levels, and contract terms while balancing cost savings, quality of care, and regulatory requirements.

• Monitors contract performance and financial outcomes by partnering with Pharmacy Finance and Business Operations to track compliance, rebates, formulary adherence, service levels, and key performance metrics.

• Collaborates across Pharmacy, Payer Relations, Health Plan leadership, Legal, Finance, Operations, Clinical, and Revenue Cycle teams to align contracting strategies and serve as a subject matter expert.

• Maintains awareness of market trends, regulatory changes, government programs, and competitive benchmarks to recommend contract updates, support organizational strategy, and identify new partnership opportunities.

 

This position does not require a pharmacy license and has no responsibility for providing care to patients.

 

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

 

Essential Functions

Job Specific Responsibilities and Accountabilities

• Performs to required standards for job specific responsibilities and technical competencies.

Talent Management

• Hiring, training, developing, and communicating with staff.

Financial Management

• Responsible for developing, monitoring and achieving budget goals.
• Manages labor and non-labor expenses to budget or flex budget.
• Manages revenue to budget to maximize potential revenue.

EPE/Service

• Responsible for patient satisfaction scores within assigned area(s).
• Responsible for upholding PROMISE standards of direct reports and team members.

Quality

• Responsible to achieve quality goals for assigned area(s).
• Manages and promotes continuous process improvements in assigned area(s).

Performance Management

• Responsible to provide staff feedback on performance, including on-time appraisals and coaching.
• Responsible to deal with conflicts in a proactive manner and to reach resolution in a timely manner.

Building Relationships

• Forms positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.
• Actively engages staff with updates and news as well as involving staff in decisions and work teams. Provides feedback and recognition when appropriate.

Knowledge / Skills / Abilities

• Comprehensive knowledge of healthcare managed care principles.

• Self-motivated with effective time-management skills.

• Working knowledge of healthcare financing and billing principles and operations.

• Knowledge of legal principles and contract language.

• High degree of effective oral and written communication skills.

• Working knowledge of various reimbursement methodologies including DRGs, per diem, RVUs.

Required

• Bachelor's degree in Business, Accounting, Health Care Administration, Nursing, or a related field, or equivalency.
• Four years of progressively more responsible managed care and contract related experience.

Preferred

• Master's degree in a related field, or equivalency.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Carrying, Climbing, Color Determination, Crawling, Far Vision, Lifting, Listening, Manual Dexterity, Near Vision, Non Indicated, Pulling and/or Pushing, Reaching, Sitting, Speaking, Standing, Stooping and Crouching, Tasting or Smelling, Walking