Director Pricing CarelonRx

Anticipated End Date:

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Job Description:

Director Pricing - CarelonRx

Location: This field-based role enables associates to primarily operate in the field traveling to client sites or designated locations as their role requires with occasional office attendance for meetings or training. This approach ensures flexibility responsiveness to client needs and direct hands-on engagement Alternate locations may be considered.

Please note that per our policy on hybrid/virtual work candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.

The Director Pricing leads pricing strategy financial modeling and payor negotiation support for infusion and specialty pharmacy services and ensures that standardized and approved processes are utilized for pricing governance contract financial review/approval and post-implementation performance monitoring to drive competitive compliant and profitable reimbursement across commercial Medicare Medicaid and employer-sponsored plans supporting both pharmacy and medical benefit structures.

How you will make an impact:

• Develops and maintains pricing models across drug professional supply and ancillary components; evaluates the financial impact of proposed payor terms (rates fees discounts carve-ins/outs performance guarantees); and leads scenario modeling for new opportunities network expansions and renegotiations across both infusion and specialty pharmacy.

• Serves as the pricing lead for payor negotiations with national regional and local health plans PBMs and employer groups; and translates complex reimbursement methodologies (AWP ASP WAC per diem case rates bundled payments value-based arrangements) into executive-level insights to inform contracting strategy.

• Supports network participation strategy including access tiering and site-of-care considerations; and reviews and approves financial terms for LOIs amendments and MSAs ensuring alignment between reimbursement and drug acquisition cost.

• Analyzes contract performance after implementation to confirm expected reimbursement and margin outcomes at both the contract and drug level identifies underperforming contracts or therapies and recommends remediation strategies.

• Partners with Revenue Cycle Billing Trade Finance and Operations to ensure pricing terms are operationalized accurately and consistently and reflect real-world purchasing and reimbursement dynamics; and supports audit responses related to pricing reimbursement and contract interpretation.

• Establishes pricing governance approval processes and documentation standards; acts as a strategic advisor to Contracting Sales and Executive leadership; and manages/mentors pricing analysts or managers as applicable including future team build-out.

Minimum Requirements:

Requires a Bachelors degree in Finance Economics Business Healthcare Administration or related field and 812 years of experience in healthcare pricing payor contracting or financial strategy including direct experience with infusion and/or specialty pharmacy reimbursement and contracting; deep understanding of reimbursement methodologies (AWP ASP WAC per diem case rates bundled pricing); advanced financial modeling and Excel skills; and experience supporting negotiations with commercial health plans PBMs and government payors; or any combination of education and experience which would provide an equivalent background.

Preferred Skills Capabilities and Experience:

• MBA/advanced degree with experience in home infusion specialty pharmacy AICs health system-based pharmacy services and strong understanding of Medicare Part B Part D Medicaid and value-based/alternative payment models preferred.

• Experience building and maintaining end-to-end financial models that incorporate drug acquisition cost reimbursement methodologies utilization and site-of-care dynamics across both infusion and specialty pharmacy preferred.

• Strong understanding of trade (drug purchasing) reimbursement and profitability including ability to evaluate margin at the contract drug and therapy level across pharmacy and medical benefits preferred.

• Experience supporting pricing strategy across both PBM/pharmacy benefit and health plan/medical benefit environments with ability to translate complex financial insights into negotiation and business strategy preferred.

• Proven ability to work cross-functionally with contracting finance trade operations and clinical teams including experience in consultative or analytics-driven roles building scalable pricing tools and governance processes preferred.

• Demonstrated ability to support executive decision-making in fast-paced environments through advanced financial modeling ad hoc analysis and clear communication of complex pricing and reimbursement dynamics preferred.

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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.

We offer a range of market-competitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13 the posting will automatically come down on 3/12 at 11:59:59 other words the job is posted until 3/13 not through 3/13.