Job Title

About AmeriPharmaAmeriPharma 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.AmeriPharma's BenefitsFull benefits package including medical, dental, vision, and life Great pay and general compensation structuresEmployee assistance program to assist with mental health, legal questions, financial counseling etc.Comprehensive PTO and sick leave options401k and matching programsCompany sponsored outings and team-building eventsJob Summary The Director of Payor Contracting & Network Development is responsible for leading strategic payer relationships and ensuring the successful negotiation and execution of contracts. This role serves as the primary leader between AmeriPharma and insurance payers, focusing on establishing long-term, community-oriented and market partnerships throughout the United States. The Director will oversee the market development through key payer relationships growth, in states and regional markets of opportunity for in-network contract relationships, and strategically assessing opportunities to improve financial performance, and operational efficiency. The Director will develop a payor relations and contracting strategy to present to the Executive team for company goals alignment. The Director must have current, established experience in the specialty pharmacy, infusion therapy, with deep experience and focus on Commercial plans network development and strategy.Duties and ResponsibilitiesDevelop business relationships with payers, advocate for mutual interests and ensure the organization's best interests are advanced.Must have a high sales and marketing mindset and approach to developing relationships with payer's executive level team, Director and VP levels.Requires established experience negotiating with the large Commercial plans through the U.S, and how they operate in negotiations of Specialty Pharmacy services.Duties and ResponsibilitiesDevelop business relationships with payers, advocate for mutual interests and ensure the organization's best interests are advanced.Must have a high sales and marketing mindset and approach to developing relationships with payer's executive level team, Director and VP levels.Requires established experience negotiating with the large Commercial plans through the U.S, and how they operate in negotiations of Specialty Pharmacy services.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.Create business plan for the Payer Contracting team, to present to the Executive team, to ensure strategic alignment.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.Guide practices through contract negotiations, providing support and expertise to achieve beneficial outcomes.Coordinate with various internal teams to assess the impact of payer contracts on different divisions.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.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.Keep on top of 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.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. Understand commercial insurance models, incorporating insights into contract negotiations to ensure effectiveness.Successfully represent AmeriPharma value propositions to top payer executives and collaborate with AmeriPharma's Marketing team for needed marketing tools and materials to achieve this goal.Required QualificationsPossess a deep understanding of both government programs and commercial insurance models to inform payer contract terms.Have the skills and experience of robust and effective contract negotiations and payer relationships development skills.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.Must be willing to travel for negotiations and relationship-building activities.Education and Experience RequirementsBachelor's Degree from an accredited institution or equivalent experience.8+ years of experience in pharmacy contracting, pharmacy quality improvement, and/or pharmacy regulatory and payer compliance.9+ years of professional experience in contract management or payer relations role, particularly within the healthcare space (specialty pharmacy and/or infusion therapy preferred).8+ 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. Required SkillsSkilled in developing and implementing performance improvement plans to enhance team efficiency andproductivity.In-depth knowledge of pharmacy systems, workflows, and claims adjudication, with expertise in claimrejections 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 at the executive leadership level.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.Pay Range: $180,000- $190,000 base with bonus structure for performance annually, DOEAmeriPharma's 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 accommodation may be made to enable individuals with disabilities to perform the essential functions and expectationsEEO Statement The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All 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 based on disability or any other legally protected class.