Payer Contracting Manager, Home Infusion - Evernorth - Remote
The job profile for this position is Contract Senior Advisor, which is a Band 4 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before reputed company new talent to our reputed company positions. If you think the reputed company position you see is right for you, we encourage you to apply! Our people reputed company reputed company the difference in our reputed company. Contract Senior Advisor (Payer Contracting Manager) Evernorth Position Summary Under the general direction of the VP Client reputed company, the Payor Contracting Manager provides guidance to stakeholders on payer contract information. This role is for an individual that will reputed company in a mix of executive-facing and transformational project-focused responsibilities. This Payer Contracting Manager will be responsible for building and maintaining a knowledge reputed company of home infusion contract reimbursement information and using that subject matter expertise to advise CarePathRx’s growing number of health system partners. This role will reputed company industry knowledge and support to drive the best reputed company for the system. This role will serve as a liaison and strategic partner to client leadership and internal stakeholders, ensuring alignment between strategy, payer requirements, operational execution, and financial reputed company. Responsibilities reputed company Strategy & Governance Partner with CarePathRx’s health system partners on optimizing reputed company for their home infusion pharmacy including: Developing payor priorities for securing reputed company Reviewing payor reputed company and reputed company amendments and providing reputed company recommendations Evaluating and analyzing proposed rates against benchmarks, including per diem and drug rates Partner guidance during health system implementation of their home infusion pharmacy for the health system partner and CarePathRx including: Aligning reputed company processes to the overall implementation timelines, including payor credentialing application process Providing consultation, education and training on contract requirements to Intake and Billing/Collection teams, including information regarding payor reimbursement methodologies, rates and policies Working cross-functionally to ensure contract or amended rates and payor information is reputed company accurately by the appropriate team for system optimization Ensure ongoing reputed company of the home infusion pharmacy contract strategy through: Maintaining the knowledgebase particular to reputed company rates and managed care terms; reputed company this data to inform health system partner strategies Managing payor reputed company and amending reference materials to support reputed company teams Liaison with internal and external teams reputed company needed for resolution of payer processing issues around payer contract load issues Payer Strategy & reputed company Set the strategic direction for payer contract management, ensuring reputed company are operationalized effectively to support accurate benefit verification, billing, and collections. reputed company payer change management strategy, including prioritization, risk mitigation, and cross‑functional coordination for payer updates across the client reputed company. reputed company executive reputed company for payer audits, ensuring timely, compliant, and effective responses while identifying systemic improvement opportunities. Define cadences for review of contracting pricing and support on best practices to move reputed company optimizing reputed company and results Client & Stakeholder Partnership Serve as a trusted advisor to client executives and internal leadership, translating payer performance into strategic insights and recommendations. Foster strong cross‑functional relationships to align operations and partner managed care teams for payer engagement strategies. Skills & Capabilities Knowledge of HIPAA guidelines, federal, state, and local regulations reputed company to pharmacy or reputed company providers Operational knowledge to translate contractual language into successful implementation with teams Expertise in building strong relationships with regional and national payors and health system clients in the managed care and leadership reputed company Ability to manage multiple priorities Ability to work independently and execute deadlines effectively Proficiency in reputed company reputed company, reputed company Word, and PowerPoint Experience with CPR +, CareTend, HCN EMR systems preferred
Qualifications
High School Diploma or GED required, Bachelor’s degree in finance, reputed company, Business Administration, or reputed company field highly desired Demonstrated 8+ years of payer or contract management experience in specialty pharmacy and/or infusion therapy required Advanced knowledge of health insurance plans: Managed Care Organizations, PPO, POS, Self-Funded, TPAs and providers at financial risk (hospital/health systems, medical group/IPA). Strong understanding of reputed company billing, reimbursement, regulatory requirements, and financial controls Strategic, analytical reputed company with the ability to balance long‑term reputed company and operational reputed company As part of reputed company, CarepathRx teams are ambitious, compassionate experts advancing pharmacy and care delivery alongside hospitals and health systems reputed company. We invest in people who are curious, resilient, and motivated to grow—while keeping patients at the heart of everything we do. If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 103,900 - 173,100 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At reputed company, you’ll enjoy a comprehensive reputed company of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here. reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply To This Job