Strategic Director, Medical Contracting & Payer Access

Optum; Atlanta (GA); On-site; USD 135,000 - 231,000; Full time

Job summary

Optum, a global health care leader, is seeking a Senior Director of Medical Contracting & Payer Strategy to develop and execute strategies that expand payer access, increase covered lives, and improve reimbursement across PCS Pharmacies. This role leads strategic payer relationships and contract negotiations.

Success requires deep expertise in managed care, medical contracting, network development, and reimbursement strategy, plus a strong understanding of medical and pharmacy benefits.

Qualifications

• 5+ years of experience in managed care, payer contracting, provider network management, or healthcare strategy.
• 3+ years of direct medical contracting, payer negotiations, or network development experience.
• Experience working with Commercial, Medicare, and Medicaid health plans.
• Advanced knowledge of medical reimbursement methodologies, healthcare economics, and managed care principles.
• Working knowledge of pharmacy benefit design and medical/pharmacy billing and reimbursement dynamics.
• Demonstrated success developing payer access, network expansion, or reimbursement strategies.
• Demonstrated solid financial, analytical, negotiation, and relationship management skills.
• Proven ability to influence stakeholders and lead cross-functional initiatives.
• Ability and willingness to work at Eastern and Central Time Zone
• Ability to travel up to 25%

Responsibilities

• Develop and execute medical contracting and payer access strategies that support growth and reimbursement objectives
• Build and manage relationships with national and regional payers, employers, TPAs, and healthcare stakeholders
• Negotiate medical participation agreements, reimbursement arrangements, and strategic payer partnerships
• Identify growth opportunities through market intelligence, analytics, financial analysis, and out-of-network reporting
• Collaborate with Finance, Pricing, Operations, Legal, Compliance, and Account Management to implement and optimize contracts
• Monitor payer performance, reimbursement trends, and competitive dynamics to drive access, profitability, and utilization
• Provide strategic guidance and subject matter expertise to leadership and cross-functional teams
• Represent PCS Pharmacies at key payer, industry, and market access meetings
• Maintain awareness of regulatory, legislative, and industry developments affecting reimbursement and network access

Skills

Managed Care

Payer Contracting

Provider Network Management

Healthcare Strategy

Negotiation

Cross-functional Leadership

Financial & Reimbursement Acumen

Stakeholder Influence

Executive Communication

Travel Readiness

Job description

Optum, a global health care leader, is seeking a Senior Director of Medical Contracting & Payer Strategy to develop and execute strategies that expand payer access, increase covered lives, and improve reimbursement across PCS Pharmacies. This role leads strategic payer relationships and contract negotiations.

Success requires deep expertise in managed care, medical contracting, network development, and reimbursement strategy, plus a strong understanding of medical and pharmacy benefits.