Payer Contracting Manager, Infusion - Evernorth - Remote

Position: Payer Contracting Manager, Home Infusion - Evernorth - Remote
** Contract Senior Advisor (Payer Contracting Manager) Evernorth*
* ** Position Summary*
* Under the general direction of the VP Client Success, 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 Care Path Rx 's growing number of health system partners.

This role will provide industry knowledge and support to drive the best outcomes for the system.

This role will serve as a liaison and strategic partner to client leadership and internal stakeholders, ensuring alignment between strategy, payer requirements, operational execution, and financial outcomes.

** Responsibilities*
* ** Enterprise Strategy & Governance*
* Partner with Care Path Rx 's health system partners on optimizing contracts for their home infusion pharmacy including:

+ 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 Care Path Rx  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 Power Point

+

Experience with CPR +, Care Tend, 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,…