Kaylee Maher
Wadsworth
Summary
Highly accomplished healthcare management professional with over 10 years of progressive experience in PBM operations and contract management, with a background as a pharmacy technician. Results-driven Senior Network Contracting Manager with expertise in contract negotiation, regulatory compliance, and provider management. Proven track record in achieving significant financial savings through strategic pharmacy network initiatives. Proven ability to negotiate complex contracts, ensure regulatory compliance, and drive significant financial value for clients and providers.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Senior Network Contracting Manager
Navitus
Remote
12.2024 - Current
- Strategic Contracting & Financial Management: Lead negotiations for pharmacy network strategies across all lines of business (Commercial, Medicare Part D, Managed Medicaid, Exchanges, and Narrow Networks) to meet or exceed client and organizational financial needs.
- Directly supported one book of business that achieved over $60k year-over-year total in value/savings for contracted providers alone, demonstrating a significant financial impact.
- Manages over 50% of provider utilization.
- Performance and Compliance: Ensure all pharmacy networks adhere to applicable regulatory entities and contractual obligations related to Value-Based, Quality, and Performance Network initiatives.
- Auditing & Analysis: Responsible for audits of the pharmacy quality performance network and other related performance guarantees and metrics.
- Market Pricing & Network Design: Assist in interpreting data models to establish market-competitive pricing for securing new and retained business, and in determining reimbursement pricing structures to align with organizational goals.
- Contract Lifecycle Management: Oversee timely renewals and updates of financial and legal terms in pharmacy network contracts, and negotiate/execute pay-for-performance agreements.
Network Contracting Manager
Navitus
Remote
07.2023 - 12.2024
- PBM Account & Provider Management: Successfully managed relationships with multiple major providers, including CVS, Walgreens, Costco, Walmart, Rite Aid, Kroger, and others, addressing contract issues and driving service enhancements.
- Negotiation & Implementation: Negotiated pharmacy network reimbursement for Retail, Specialty, and Mail Order Networks across Commercial, Medicare Part D, and Managed Medicaid programs. Served as the Pharmacy Network Subject Matter Expert backup for key new client implementations.
- Legal & Compliance: Conducted research and implementation of legal and compliance requirements, maintaining a strong understanding of Medicare Part D, state Medicaid, state Law, and federal pharmacy regulations.
- Value Proposition: Developed value propositions to payers for preferred, narrow, specialty, and limited distribution pharmacy networks.
- Cross-Functional Collaboration: Collaborated with Provider Services Leadership, Client Services, and Sales on network pricing and pharmacy services enhancements.
Senior Network and Pricing Advisor
Abarca Health
Remote
06.2022 - 07.2023
- System Subject Matter Expert: Acted as the SME and key point of contact for DARWIN pharmacy network and pricing module related questions and projects.
- Configuration & Quality Assurance: Led the investigation of and submitted/delineated network and pricing configuration requirements to the configurations team. Supported Darwin Claims Analysts with QA and testing of network and pricing configurations.
- Project Leadership: Led the project management aspects and provided support in pharmacy network and pricing related adjudication enhancements with product development.
Education
Bachelor Of Science (BS) - Healthcare Administration
Western Governors University
Salt Lake City, UT03-2026
Skills
- Contract Negotiation & Management
- Regulatory and Legal compliance
- Pharmacy Network Design
- Reimbursement & Pricing Structures
- Data Interpretation & Financial Analysis
- Cross-Functional Collaboration
Certification
WGU Certificate: Healthcare Management
Timeline
Senior Network Contracting Manager
Navitus
12.2024 - Current
Network Contracting Manager
Navitus
07.2023 - 12.2024
Senior Network and Pricing Advisor
Abarca Health
06.2022 - 07.2023
Bachelor Of Science (BS) - Healthcare Administration
Western Governors University