Director, Payer Strategy & Contracting (Remote)

CarePoint Pharmacy; Schaumburg (IL); Hybrid; USD 140,000 - 190,000; Full time

Benefits offered by this job

Travel opportunities

Job summary

Carepoint Pharmacy is seeking a Director of Payer Contracting and Strategy to lead payer relationships and contract strategy from Schaumburg, IL (hybrid) or remote with travel.

You will establish the payer function, negotiate with PBMs and health plans, credential networks across multiple programs, and model contract economics with finance before execution. Collaboration with COO and cross-functional teams is essential.

Qualifications

• Bachelor's degree in business, healthcare administration, finance, or related field, or equivalent experience.
• 8+ years in pharmacy or healthcare payer contracting, managed care, or network management with direct negotiation responsibility.
• Credentialing a pharmacy into commercial, Medicaid, and Medicare Part D networks, including mail-order and specialty designations.
• Knowledge of pharmacy reimbursement mechanics (AWP/WAC/NADAC, DIR, MAC lists, and specialty carve-outs).
• Willingness to travel up to 25% including industry conferences.

Responsibilities

• Owns Carepoint Pharmacy's relationships with PBMs, health plans, Medicaid fee-for-service and managed care programs, Medicare Part D sponsors, and third-party network administrators.
• Negotiate participation agreements, amendments, rate schedules, reimbursement terms, and performance terms; model contract economics with finance before execution.
• Owns payer credentialing and network applications across commercial, mail-order, specialty, Medicaid, and Medicare Part D networks; secures limited-distribution and preferred-network designations.
• Monitors contract compliance and reimbursement accuracy; pursues recovery of underpayments and misapplied rates; leads payer-facing audits.
• Works with the COO and cross-functions with pharmacy operations, finance, compliance, and business development.

Skills

Contract negotiation

PBM relationships

Credentialing

Financial modeling

Contract drafting

Audit response

Cross-functional collaboration

Travel readiness

Education

Bachelor's degree or equivalent

Job description

Carepoint Pharmacy is seeking a Director of Payer Contracting and Strategy to lead payer relationships and contract strategy from Schaumburg, IL (hybrid) or remote with travel.

You will establish the payer function, negotiate with PBMs and health plans, credential networks across multiple programs, and model contract economics with finance before execution. Collaboration with COO and cross-functional teams is essential.