Payer Contracting Manager, Home Infusion - Evernorth - Remote

Cigna Health and Life Insurance Company; Northern (KY); Hybrid; USD 104,000 - 173,000; Full time

Benefits offered by this job

Health benefits

401(k)

Paid time off

Tuition reimbursement

Life insurance

Holidays

Job summary

Cigna Health and Life Insurance Company seeks a Contract Senior Advisor to guide payer contracting, executive engagement, and strategic governance for home infusion partnerships. You will build knowledge on reimbursement, align payor requirements with operations, and drive financial outcomes across health system partners.

The role emphasizes cross-functional leadership, change management, and advisory support to client leadership and internal teams.

Qualifications

• 8+ years of payer or contract management experience in specialty pharmacy and/or infusion therapy.
• Advanced knowledge of health insurance plans: MCOs, PPO, POS, Self-Funded, TPAs.
• Strong understanding of healthcare billing, reimbursement, regulatory requirements, and financial controls.
• Strategic, analytical mindset balancing long-term vision with operational outcomes.

Responsibilities

• Develop payor contracts optimization with health system partners.
• Review payor contracts and amendments; provide recommendations.
• Evaluate proposed rates against benchmarks (per diem and drug rates).
• Oversee payer change management and cross-functional coordination for updates.
• Serve as trusted advisor to client executives translating payer performance into insights.

Skills

HIPAA knowledge

Regulatory knowledge

Contract management

Executive communication

Relationship building

Project management

Excel

Word

PowerPoint

Education

High School Diploma or GED

Bachelor's degree in finance/Accounting/Business Administration

Tools

CPR+

CareTend

HCN EMR systems

Job description

**Contract Senior Advisor (Payer Contracting Manager) Evernorth****Position Summary**Under the general direction of the VP Client Success, the Payor Contracting Manager provides guidance to stakeholders on payer contract information. This role is for an individual that will excel in a mix of executive-facing and transformational project-focused responsibilities. This Payer Contracting Manager will be responsible for building and maintaining a knowledge base 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 provide industry knowledge and support to drive the best outcomes 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 outcomes.**Responsibilities****Enterprise Strategy & Governance**Partner with CarePathRx’s health system partners on optimizing contracts for their home infusion pharmacy including:* Developing payor priorities for securing contracts* Reviewing payor contracts and related amendments and providing related 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 all 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 loaded accurately by the appropriate team for system optimization* Ensure ongoing success of the home infusion pharmacy contract strategy through:* Maintaining the knowledgebase particular to benchmark rates and managed care terms; leverage this data to inform health system partner strategies* Managing payor contracts and amending reference materials to support all teams* Liaison with internal and external teams when needed for resolution of payer processing issues around payer contract load issues**Payer Strategy & Oversight*** Set the strategic direction for payer contract management, ensuring contracts are operationalized effectively to support accurate benefit verification, billing, and collections.* Oversee payer change management strategy, including prioritization, risk mitigation, and cross‐functional coordination for payer updates across the client base.* Provide executive oversight 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 forward optimizing outcomes 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 related to pharmacy or healthcare 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 arena* Ability to manage multiple priorities* Ability to work independently and execute deadlines effectively* Proficiency in Microsoft Excel, Microsoft Word, and PowerPoint* Experience with CPR +, CareTend, HCN EMR systems preferred**Qualifications*** High School Diploma or GED required, Bachelor’s degree in finance, Accounting, Business Administration, or related 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 healthcare billing, reimbursement, regulatory requirements, and financial controls* Strategic, analytical mindset with the ability to balance long‐term vision and operational outcomesAs part of Evernorth Health Services, CarepathRx teams are ambitious, compassionate experts advancing pharmacy and care delivery alongside hospitals and health systems nationwide. 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 connection 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 The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, 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.