Manager, Payor Contracting & Network Development

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas creativity and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

AmeriPharmas Benefits

• Full benefits package including medical dental vision life that fits your lifestyle and goals
• Great pay and general compensation structures
• Employee assistance program to assist with mental health legal questions financial counseling etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company sponsored outings and team-building events
• Casual Fridays

Job Summary

The Manager Payor Contracting & Network Development is responsible for effectively managing strategic payer relationships and ensuring the successful negotiation and execution of contracts. This role serves as the primary liaison between AmeriPharma and its payers focusing on establishing genuine long-term community-oriented partnerships. The manager will oversee optimization the development negotiation and compliance of payer contracts while strategically assessing opportunities to improve financial performance operational efficiency and contract terms. The manager will ensure alignment with AmeriPharmas contracting standards while proactively identifying opportunities for relationship enhancement and contract optimization. A deep understanding of the specialty pharmacy infusion therapy and healthcare contracting landscape will be essential for success in this role.

Duties and Responsibilities

• Develop sincere business relationships with payers advocate for mutual interests and ensure theorganizations best interests are advanced.
• Engage strategically with payers to foster associations that advance AmeriPharmas community commitments.
• Lead the drafting negotiation and execution of payer contracts to ensure favorable and equitable terms forAmeriPharma.
• 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-functionalalignment and execution.
• Maintains organizational documents for educating appropriate subsidiaries on managed care contractsincluding 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 accessand 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 withpayer-specific policies.
• Contribute to the strategic direction of payer contracting ensuring contracts align with company goals andmarket demands.
• Stay informed on industry trends regulatory changes and payer-specific policies that could affect contractperformance and enhance awareness within theorganizations business models.
• Communicate policies and procedures clearly to payers addressing inquiries confidently to ensure clarityand efficiency.
• Stay informed on healthcare market trends proposing strategic adjustments to contracts to enhanceAmeriPharmas market position.
• Analyze financial data to inform decision-making and contribute to leadership discussions.
• Ensure the accurate creation and documentation of all payer contracts synthesizingcomplex 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 aligningdepartmental 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 organizations objectives are supported.
• Maintain a working knowledge of government healthcare plans and advocate for effective contracts withinthose frameworks.
• Understand commercial insurance models incorporating insights into contract negotiations to ensureeffectiveness.
• Represent AmeriPharma with confidence and enthusiasm establishing credibility in all payer discussions.

Required Qualifications

• Possess a deep understanding of both government programs (Medicare Medicaid TriCare) and commercialinsurance 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.

Education and Experience Requirements

• Bachelors Degree from an accredited institution or equivalent experience.
• 6 years of experience in pharmacy contracting pharmacy quality improvement and/or pharmacy regulatoryand payer compliance.
• 5 years of professional experience in contract management or payer relations role particularly within thehealthcare space (specialty pharmacy and/or infusion therapy preferred).
• 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 payerorganizations.

Required Skills

• 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 relationshipswith 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 anddelegation 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.

Pay Range: $130000-$170000 Annually DOE

AmeriPharmas Mission Statement

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients prescribers colleagues and others that We Care!

Physical Requirements

The following physical activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and expectations

EEO Statement

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be anexhaustive list of all responsibilities duties and skills required. The duties and responsibilities of this position are subject to change and otherduties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO qualified applicants will receive consideration for employment without regard to race sex color religion sexual orientation gender identity national origin age protected veteran status or on the basis of disability or any other legally protected class.

Required Experience:

Manager