Hybrid Payor Contract Manager - Specialty Pharmacy

Elevance Health, Inc.; Durham (NC); Hybrid; USD 111,000 - 167,000; Full time

Job summary

Elevance Health, Inc. is seeking a Payor Contract Manager (Specialty Pharmacy) to lead the lifecycle of payor contracts across specialty and infusion services. This role collaborates with finance, IT, and pharmacy operations to ensure compliant pricing and claim adjudication.

The position requires a bachelor's degree and 5+ years in payor contracting or related fields, with a hybrid work arrangement of 1–2 days in office and potential alternate locations within commuting distance.

Qualifications

• Bachelor’s degree as stated or equivalent combination of education and experience.
• Minimum of 5 years of experience in payor contracting, managed care, or contract administration in specialty pharmacy, infusion pharmacy, PBM, or health plan environments.
• Equivalents accepted per job policy.

Responsibilities

• Manages lifecycle of payor contracts including review, interpretation, implementation, amendments and renewals.
• Serves as subject matter expert on contract terms: reimbursement methodologies, fee schedules, carve-outs, drug pricing, site-of-care requirements, network participation.
• Tracks expirations, renewals and amendments to ensure access and compliance.
• Analyzes reimbursement methodologies and identifies reimbursement risks and revenue leakage.
• Collaborates with finance to resolve discrepancies and supports forecasting and profitability reporting.
• Translates contract terms into operational requirements for billing systems and pricing rules; coordinates with IT and pharmacy operations to ensure correct setup.

Skills

Payor contracting

Managed care

Contract administration

Healthcare reimbursement

Education

Bachelor’s degree in Business / Healthcare Administration / Finance / related field

Job description

Elevance Health, Inc. is seeking a Payor Contract Manager (Specialty Pharmacy) to lead the lifecycle of payor contracts across specialty and infusion services. This role collaborates with finance, IT, and pharmacy operations to ensure compliant pricing and claim adjudication.

The position requires a bachelor's degree and 5+ years in payor contracting or related fields, with a hybrid work arrangement of 1–2 days in office and potential alternate locations within commuting distance.