Strategic Payer Negotiations Lead — Remote

Lumicera; Salt Lake City (UT); Remote; USD 110.000 - 170.000; Vollzeit

Benefits dieser Stelle

Health, Dental, Vision insurance

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program – up to $750

Zusammenfassung

Lumicera Health Services is seeking a Payer Contracting Executive to join our team in the United States. The role focuses on expanding payer access across commercial, Medicare Part D, and Medicaid opportunities, leading end-to-end negotiations, network participation, and renewal strategy to grow covered lives while protecting margins for specialty pharmacy.

The successful candidate will develop payer access roadmaps, pursue new networks, manage credentialing, and ensure contract compliance with

Qualifikationen

• Bachelor's degree required.
• MBA or graduate degree preferred.
• Certified Pharmacy Technician or relevant certification preferred.
• 5 years of payer contracting, managed care, or specialty pharmacy experience required.
• Experience negotiating payer or network agreements, preferably in specialty pharmacy or managed care contracting, required.
• Working knowledge of commercial, Medicare Part D, and Medicaid payer environments and network access requirements required.
• Participate in, adhere to, and support compliance program objectives.

Aufgaben

• Lead payer negotiations end to end, including rate and term negotiation, network participation, performance guarantee structures, and renewal strategy.
• Develop and execute a payer access roadmap for expanded payer contracts, investigating current networks where Lumicera and its partner pharmacies are not in network.
• Independently outreach to payers to identify credentialing and network requirements and to pursue new access opportunities.
• Establish, monitor, and negotiate pricing and service agreements with payers, following company policy regarding contract management, including legal and compliance review and oversight.
• Complete credentialing and new contract applications for payer and government clients, and compile supporting documents and reports for payer applications, contracts, and business reviews.
• Track agreements through the contracting process from reception to completion with both internal and external stakeholder input.
• Meet with payer representatives to determine account management needs of the payer and to ensure contract compliance.
• Reenroll and recredential existing payer and government plans, monitoring proactively to ensure no gaps in coverage.

Kenntnisse

Payer contracting

Negotiation

Managed care knowledge

Network access

Cross-functional collaboration

Ausbildung

Bachelor's degree

MBA or graduate degree

Certified Pharmacy Technician

Jobbeschreibung

Lumicera Health Services is seeking a Payer Contracting Executive to join our team in the United States. The role focuses on expanding payer access across commercial, Medicare Part D, and Medicaid opportunities, leading end-to-end negotiations, network participation, and renewal strategy to grow covered lives while protecting margins for specialty pharmacy.

The successful candidate will develop payer access roadmaps, pursue new networks, manage credentialing, and ensure contract compliance with