Director of Payor Contracting – Specialty

Anticipated End Date:

Position Title:

Job Description:

Director of Payor Contracting Specialty

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 Payor Contracting directs the enterprise payor contracting strategy for a specialty pharmacy organization and ensures that standardized and approved processes are utilized for payor relationship management contract negotiation network participation strategy and reimbursement optimization across commercial Medicare Medicaid and employer-sponsored plans with a primary focus on pharmacy benefit-driven specialty networks and PBM access.

How you will make an impact:

• Develops and leads a comprehensive contracting strategy aligned with growth goals across specialty pharmacy including oral and self-administered injectable therapies specialty distribution models and limited distribution drug (LDD) access.

• Serves as a strategic advisor to executive leadership on PBM and specialty network trends access barriers reimbursement risk and evolving regulatory/CMS considerations impacting pharmacy benefit structures.

• Leads complex negotiations with national and regional PBMs and specialty networks to secure and expand network participation including drug-level pricing access criteria performance guarantees and specialty carve-out structures.

• Oversees contract modeling financial impact analysis approval governance and ongoing performance monitoring to ensure contracts meet margin growth and access objectives in a highly competitive and saturated specialty market.

• Partners with finance and analytics to evaluate pharmacy benefit reimbursement methodologies and drug-level economics ensuring alignment between acquisition cost reimbursement and margin performance.

• Acts as the primary liaison between contracting and internal stakeholders including operations revenue cycle clinical leadership legal/compliance trade and reporting teams ensuring specialty contracts are operationalized across the full contract lifecycle.

• Leads mentors and develops a team of payor contracting professionals and contract managers building scalable processes to support high-volume network applications credentialing requirements and audit readiness.

• Ensures contracting activities align with federal and state regulations CMS requirements and PBM-specific audit and compliance expectations including performance guarantees reporting obligations and specialty pharmacy accreditation standards.

Minimum Requirements:

Requires a Bachelors degree and minimum of 10 years of progressive experience in payor contracting reimbursement or managed care within specialty pharmacy infusion services PBM or health plan environments including demonstrated success leading complex national and regional negotiations and proven people leadership experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills Capabilities and Experience:

• MBA/advanced degree with deep experience in specialty pharmacy including limited distribution drugs (LDDs) specialty carve-outs value-based/outcomes-based contracts and strong understanding of Medicare Part D Medicaid and commercial payor dynamics preferred.

• Proven experience negotiating with PBMs and securing access into specialty pharmacy networks including application-based entry accreditation and audit readiness requirements preferred.

• Strong knowledge of specialty drug landscape including disease states drug pipelines utilization management and drug-level contracting strategies tied to reimbursement and access preferred.

• Demonstrated ability to drive revenue through network access strategy in a highly competitive saturated specialty market including partnership with trade operations RCM and clinical teams preferred.

• Experience leading large complex teams including contract managers and credentialing functions with strong interpersonal consultative and influencing skills preferred.

• Experience supporting government programs (Medicare Medicaid) and ensuring compliance with CMS requirements coupled with strong executive presence communication and strategic decision-making capabilities preferred.

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Workshift:

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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.