Specialty Pharmacy Account Manager

Elevance Health; Durham (NC); Hybrid; USD 85,000 - 120,000; Full time

Job summary

Elevance Health is seeking a Hybrid Specialty Pharmacy Account Manager to lead strategic planning and account management for major payor accounts. The role involves directing payor contract requirements, supporting new and renewal implementations, and coordinating with operations to ensure smooth service delivery.

You will maintain relationships across health plans and PBMs, recommend improvements, and deliver on-site and off-site support including plan design interpretation and inquiries.

Qualifications

• BA/BS required with at least 3 years of experience in operations or customer relationships.
• Experience with payor contracts and health plan relationships preferred.
• Familiarity with payor reporting and contract administration is a plus.

Responsibilities

• Provides strategic planning and account management for large payor accounts.
• Directs and manages administration of payor contractual requirements.
• Assists with new and renewal implementation processes for accounts.
• Interfaces with operations to ensure smooth service delivery.
• Maintains payor relationships at multiple levels within health plans and PBMs.
• Makes recommendations to improve performance and meet expectations.
• Provides on-site and off-site customer service, including plan design interpretation and inquiries.
• Prepares and submits required health plan and PBM reports and metrics.
• Manages payor and payor contract programs.

Skills

Strategic planning

Account management

Contract administration

Customer service

Payor relationships

Cross-functional collaboration

Data interpretation

Payor reporting

Operations liaison

Education

BA/BS degree

Tools

Smartsheet

Excel

Job description

Specialty Pharmacy Account Manager - BioPlus Specialty Pharmacy

Hybrid: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Anticipated Schedule: Monday - Friday 8:00am to 5:00pm EST.

The Specialty Pharmacy Account Manager (Account Service Manager, Payor Contracting) is responsible for providing advanced customer service representation and strategic planning for large accounts.

How you will make an impact:

• Provides strategic planning and account management for larger payor accounts.


• Directs and manages the administration of payor contractual requirements and obligations.


• Assists with the management of the new and renewal implementation process for accounts.


• Interfaces with operations to ensure smooth delivery of services.


• Maintains ongoing payor account relationships at multiple levels throughout the health plan and PBM organizations.


• Makes recommendations for improvements to meet expectations.


• Provides both on-site and off-site customer service, which may include interpreting plan design, researching and resolving phone and written inquiries, resolving claims, benefit, and enrollment issues.


• Prepares and submits contractually required health plan and PBM reports and metrics.


• Program management of payors and payor contracts.

Minimum Requirements:

• Requires a BA/BS and a minimum of 3 years of experience managing business operations and/or customer relationship; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Specialty and Infusion Pharmacy experience strongly preferred.


• Payor contract, health plan, and PBM experience preferred.


• Smartsheet and Excel proficiency for payor reporting experience preferred.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.