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AmeriPharma · 2 months ago

Manager, Payor Contracting & Network Development

Laguna Hills, California, United States

Full-time

Onsite

Mid, Senior Level

$130K/yr - $170K/yr

6+ years exp

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. The Manager, Payor Contracting & Network Development is responsible for effectively managing strategic payer relationships and ensuring the successful negotiation and execution of contracts, while focusing on optimizing financial performance and operational efficiency.

Health CarePharmaceutical

Growth Opportunities

Responsibilities

Develop sincere business relationships with payers, advocate for mutual interests and ensure the organization’s best interests are advanced

Engage strategically with payers to foster associations that advance AmeriPharma's community commitments

Lead the drafting, negotiation, and execution of payer contracts to ensure favorable and equitable terms for AmeriPharma

Monitor financial performance across payer contracts, ensuring compliance, maintaining fairness and consistency across all payer agreements, and identifying areas for improvement or adjustment

Oversee the payer relation team to implement and maintain payer contracts, ensuring cross-functional alignment and execution

Maintains organizational documents for educating appropriate subsidiaries on managed care contracts, including but not limited to contract databases and matrixes

Facilitates problem solving of escalated contractual, payer policy and operational issues through collaboration with managed care organizations and internal stakeholders

Collaborate with practices to develop effective payer contracting strategies that optimize network access and reimbursement

Guide practices through contract negotiations, providing support and expertise to achieve beneficial outcomes

Coordinate with various internal teams to assess the impacts of payer contracts on different divisions

Manage contract-related challenges and opportunities within assigned areas

Serve as a subject matter expert on pharmacy and medical contracting including but not limited to managed care; specialty, long-term care, and home infusion networks; Pharmacy Service Administration Organizations (PSAOs); Pharmacy Benefit Management (PBMs) and other relations

Ensure that contracts meet all regulatory requirements and incorporate effective strategies for dealing with payer-specific policies

Contribute to the strategic direction of payer contracting, ensuring contracts align with company goals and market demands

Stay informed on industry trends, regulatory changes, and payer-specific policies that could affect contract performance, and enhance awareness within the organization’s business models

Communicate policies and procedures clearly to payers, addressing inquiries confidently to ensure clarity and efficiency

Stay informed on healthcare market trends, proposing strategic adjustments to contracts to enhance AmeriPharma's market position

Analyze financial data to inform decision-making and contribute to leadership discussions

Ensure the accurate creation and documentation of all payer contracts, synthesizing complex information into clear and concise contract terms

Present complex contract terms and performance data in a professional and understandable manner to internal stakeholders

Oversee contract performance and compliance through detailed reporting and regular evaluations

Demonstrate knowledge of payment methodologies for commercial and government payers, aligning departmental processes accordingly

Lead and oversee payer contracting projects and coordination efforts within the organization for new contract opportunities, risks, and challenges, ensuring goals are met and the organization’s objectives are supported

Maintain a working knowledge of government healthcare plans and advocate for effective contracts within those frameworks

Understand commercial insurance models, incorporating insights into contract negotiations to ensure effectiveness

Represent AmeriPharma with confidence and enthusiasm, establishing credibility in all payer discussions

Qualification

Payer contractingPharmacy systems knowledgeContract negotiationHealthcare complianceData analysisMicrosoft OfficeVerbal communicationProblem-solvingInterpersonal skillsTime management

Required

Possess a deep understanding of both government programs (Medicare, Medicaid, TriCare) and commercial insurance models to inform payer contract terms

Ability to manage large volumes of complex contracts and projects while adhering to deadlines

Familiarity with claims adjudication and resolving non-compliance issues

Proficiency in word processing, spreadsheets, databases, and scheduling applications

Exceptional verbal communication skills for presenting complex topics clearly

Experience in synthesizing extensive data into concise summaries

Willingness to travel for negotiations and relationship-building activities

Bachelor's Degree from an accredited institution or equivalent experience

6+ years of experience in pharmacy contracting, pharmacy quality improvement, and/or pharmacy regulatory and payer compliance

3+ years of experience in writing, negotiating, and managing healthcare payer contracts

Proven experience in managing relationships and negotiating with health plans, PBMs, and other payer organizations

Skilled in developing and implementing performance improvement plans to enhance team efficiency and productivity

In-depth knowledge of pharmacy systems, workflows, and claims adjudication, with expertise in claim rejections and resolutions

Strong ability to manage customer expectations, resolve service-related issues, and foster positive relationships with clients

Proficient in Microsoft Office and communication platforms, with excellent verbal and written communication skills to facilitate clear information exchange

Demonstrated ability to interpret and apply industry guidelines, ensuring compliance, accuracy, and risk management

Expertise in fostering effective working relationships with payers, staff, and coworkers to enhance collaboration and team morale

Strong analytical, problem-solving, and decision-making skills, with a focus on achieving measurable outcomes

Focused on continuous quality improvement, actively reviewing and self-monitoring work for optimal results

Maintains confidentiality and works independently, demonstrating strong prioritization, time management, and delegation skills

Excellent interpersonal skills, with a track record of providing exceptional customer service and displaying keen organizational and attention-to-detail abilities

Ability to manage multiple tasks, delegate appropriately, and thrive in high-pressure environments, balancing workload across team members while ensuring quality delivery

Preferred

5+ years of professional experience in contract management or payer relations role, particularly within the healthcare space (specialty pharmacy and/or infusion therapy preferred)