Payer Contracting Manager, Home Infusion - Evernorth - Remote

Evernorth Health Services; United States; Hybrid; USD 104,000 - 173,000; Full time

Benefits offered by this job

Annual bonus plan

Comprehensive benefits package

Job summary

Evernorth is seeking a Contract Senior Advisor to lead payer contracting strategy and execution, focusing on home infusion contract reimbursement. The role collaborates with executives and health system partners, translating complex contract terms into actionable guidance and optimizing reimbursement outcomes.

You will drive governance, manage relationships with payors, and oversee implementation efforts across care pathways while leveraging industry knowledge to improve system performance.

Qualifications

• 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
• Strong understanding of healthcare billing, reimbursement, regulatory requirements, and financial controls
• Strategic, analytical mindset with the ability to balance long-term vision and operational outcomes

Responsibilities

• Develop payor priorities for securing contracts and reviewing payor contracts with amendments
• Evaluate proposed rates against benchmarks (per diem and drug rates)
• Guide health system implementation of home infusion pharmacy and ensure accurate load of payor information
• Provide consultation and training on contract requirements to Intake and Billing/Collections teams
• Maintain knowledgebase on benchmark rates and managed care terms to inform partner strategies
• Oversee payer contract management and reference materials; coordinate cross-functional resolution of issues
• Set strategic direction for payer contract management to support accurate benefit verification, billing, and collections
• Define cadence for contracting pricing reviews and share best practices to improve outcomes
• Serve as trusted advisor to client executives translating payer performance into strategic insights
• Foster cross-functional relationships to align operations for payer engagement strategies

Skills

HIPAA knowledge

Regulatory knowledge

Payor relationships

Multitasking

Independence

Excel

Word

PowerPoint

CPR+

CareTend

HCN EMR

Education

High School Diploma or GED

Bachelor’s degree in finance, accounting, business administration, or related field

Tools

CPR+

CareTend

HCN EMR

Job description

Contract Senior Advisor (Payer Contracting Manager) Evernorth

Position Summary

Under the general direction of the VP Payor Relations, 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.

Responsibilities

Enterprise Strategy & Governance

• 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 outcomes

As 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.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, 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.

If you need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.