Director, Payer Services

Job Summary

As the Director of Payer Services, you will lead the strategy, development, and execution of Walgreens Specialty Pharmacy's payer programs and contracts. This highly visible leadership role oversees payer compliance, implementation, utilization management, pricing, contracting, and performance initiatives while partnering with key clients, senior leaders, and cross-functional teams. The ideal candidate is a strategic and innovative leader who excels at solving complex business challenges, driving operational excellence, and leading teams through enterprise-wide initiatives that deliver value to both customers and the organization.

• Develops and negotiate contracts that position the company to be successful, including improving financial performance, driving volume and creating contracts that incentivize improvement in the quality of the services the company offers
• Ensures execution of contracting goals and objectives related to contract language and pricing, planning and execution, and revenue cycle support
• Develops positive relationships with payers to facilitate a collaborative exchange of information and promote responsiveness to requests.
• Leads the collaboration with internal stakeholders to build the top line revenue strategy, including finance, technology services, business development, operations, credentialing, etc. in order to meet the objectives negotiated in each payer contract
• Develops and execute communication plans to internal stakeholders related to payer relationships, negotiations, and contractual obligations
• Oversees the department to manage the contracting process including contract amendments, credentialing, payer complaints, database of account contacts and key account information
• Ensures compliance with contracts, performance guarantees, legal requirements and company policies and procedures; stay abreast of all market relevant data including current healthcare trends, insurance products, competition, legislation, and pricing
• Leads the collaboration internally and externally for strategic payer products
• Leads the teams that oversees and coordinates all external payer audits of contract adherence (including desk audits, onsite audits
• Oversees the pricing strategy for Walgreens Specialty Pharmacy.
• Leads the collaboration and oversees the Implementation Team and performance guarantee process
• Leads the patient, provider and client customer satisfaction across specialty and home delivery.
• Supports RFPs and client finalist presentations.
• Supervisory Responsibilities
• Develops the strategy and the execution of market insights for the specialty division, including the management of internal teams and the relationship with all external contracted vendors.
• Owns the specialty biosimilar strategy offering for payer and PBM clients, including developing unique products and services.
• Responsible for the strategies related to optimizing channel performance and profitability amongst our central, community, and retail specialty pharmacy assets.
• Responsible for the development, oversight and implementation of departmental budget
• Responsible for leading a team through teaching, coaching and inspiring by fostering a sense of energy, ownership and a responsibility for the flawless execution of operational excellence engage in the selection and hiring process as needed.
• Strong knowledge of pharmacy applications across both central and community-based specialty.
• Other responsibilities as judgment or necessity dictate

Founded in 1901, Walgreens () has a storied heritage of caring for communities for generations and proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico, and leading omni channel platforms. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for retail pharmacy and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

• Bachelor's degree in Healthcare, Business Administration, Finance, or related area of study; or equivalent combination of education and/or relevant work experience
• 10 years' work experience in the healthcare field or insurance industry including direct managed care experience (either hospital or payer based), payer contracting, and contract negotiation experience
• 5 years of direct and cross functional leadership/ people management experience
• Demonstrated understanding pay for performance contracting methodologies
• Strong healthcare experience; integrated healthcare (payer, provider and patient) preferred Demonstrated organizational skill with keen attention to detail and documentation
• Experience in representing the company in industry and trade groups, key physician providers, government representatives and regulatory agencies, brokers, and the general public
• Experience with strategy…