Sr. Advisor, Payor Relations and Engagement (Cell & Gene Specialty Pharmacy)

What Advanced Therapy Solutions Contributes to Cardinal Health

Advanced Therapy Solutions (ATS) is dedicated to supporting biopharma pioneers in delivering cell and gene therapies (CGTs) to patients who need them. From clinical development to commercialization our experts partner with pharma and payers to ensure these critical therapies reach patients. We have processed over 15000 CGT orders and support more than 425 active sites of care administering CGTs.

This new specialty pharmacy will serve manufacturers providers and patients in the cell & gene space (among other areas). The Sr. Advisor Payor Engagement Executive (Cell & Gene Specialty Pharmacy) will focus on payor engagement and negotiation.

Location - Targeting individuals local to Nashville TN (or surrounding areas) who are willing and able to work on-site 5 days a week at our specialty pharmacy in LaVergne TN

Responsibilities

• Building a Specialty Pharmacy:Develop and enhance specialty pharmacy capabilities to support the distribution and administration of CGT products.
• Payor Relations:Develop and maintain strong relationships with payors to facilitate smooth negotiations and resolution of coverage issues.
• Individual Case Negotiations:Negotiate agreements with payors to secure coverage and reimbursement rate for advanced therapy / CGT products.
• Prior Authorizations:Manage the prior authorization process for CGT products including outreach to providers to collect all necessary documentation submission to payor follow-up and resolution of authorization requests.
• Expanding Distribution Channels:Partner with CGT manufacturers to expand their distribution channels ensuring broader access to innovative therapies.
• Claims Adjudication:Oversee the claims adjudication process ensuring timely and accurate processing of ATSP claims for CGT treatments.
• Compliance:Ensure all contracting and claims activities comply with regulatory requirements and company policies.
• Documentation:Maintain comprehensive documentation of all negotiations authorizations and claims activities.
• Collaboration:Work closely with the pharmacy team healthcare providers and manufacturers to ensure seamless coordination of CGT treatments.
• Education:Provide education and training to pharmacy staff on payor requirements and best practices for managing authorizations and claims as needed.
• Leadership. Ability to make decisions and lead in a startup-like environment working collaboratively with a small team and cross-functionally to effectively grow a new business unit.
• Quality and Compliance:Maintain the highest standards of quality and compliance in all pharmacy operations ensuring patient safety and product integrity.
• Patient-Centric Care:Foster a patient-centric approach to care prioritizing patient experience and outcomes through high-touch personalized services.
• Innovation and Collaboration:Drive innovation and collaboration across the ATS team and with external partners to continuously improve service offerings and patient care.

Qualifications

• Ideally targeting individuals with experience working at a specialty pharmacy well versed in payor contracting (have led or owned contract negotiation processes for cell & gene therapies either at a health system or payor) highly preferred
• Experience with prior authorization approvals and medical/pharmacy benefit billing & coding both highly preferred
• Excellent verbal and written communication (to effectively negotiate with different health care stakeholder types)
• Strong time management to enable prompt follow up to any payor or health system communications
• Strong relationship building and stakeholder management
• Demonstrated ability to think strategically and make sound recommendations.

What is expected of you and others at this level

• Applies comprehensive knowledge and a thorough understanding of concepts principles and technical capabilities to perform varied tasks and projects
• May contribute to the development of policies and procedures
• Works on complex projects of large scope
• Completes work independently and receives general guidance on new assignments
• Work reviewed for purpose of meeting objectives

Anticipated Salary Range $87700.00 - $137830.00 USD

Bonus Eligible - Yes

Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

• Medical dental and vision coverage

• Paid time off plan

• Health savings account (HSA)

• 401k savings plan

• Access to wages before pay day with myFlexPay

• Flexible spending accounts (FSAs)

• Short- and long-term disability coverage

• Work-Life resources

• Paid parental leave

• Healthy lifestyle programs

Application window anticipated to close: 01/15/2025 * if interested in opportunity please submit application as soon as possible.

The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including but not limited to a candidates geographical location relevant education experience and skills and an evaluation of internal pay equity.

Candidates who are back-to-work people with disabilities without a college degree and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race religion color national origin ancestry age physical or mental disability sex sexual orientation gender identity/expression pregnancy veteran status marital status creed status with regard to public assistance genetic status or any other status protected by federal state or local law.

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