Payer Contracting Manager
Listed on 2026-09-12
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Healthcare
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Business
The Payer Contracting Manager – Specialty Pharmacy & Home Infusion leads the development, negotiation, implementation, and ongoing management of payer contracts supporting Pure Infusion’s Specialty Pharmacy and ambulatory infusion services across a 14-state service area. This role owns assigned payer relationships, develops contracting strategies, negotiates favorable reimbursement and network participation agreements, and partners with internal stakeholders to ensure contracts are financially optimized and operationally executable.
The position collaborates closely with Revenue Cycle, Pharmacy Operations, Clinical Leadership, Credentialing, Compliance, and Finance to improve patient access, maximize reimbursement, and support strategic growth initiatives. Unlike Pure Infusion’s Alternate Site of Care (AIC)/Buy & Bill contracting team, this position focuses specifically on Specialty Pharmacy and Home Infusion reimbursement models, distribution agreements, limited distribution network participation, pharmacy benefit and medical benefit contracting, and infusion-related payer strategies.
KEY RESPONSIBILITIES- Develop and execute contracting strategies for Specialty Pharmacy and Home Infusion services across assigned payer portfolios.
- Lead negotiations for new contracts, renewals, amendments, and network participation agreements with commercial and government payers.
- Analyze reimbursement methodologies, contract performance, and financial impact to optimize reimbursement and identify renegotiation opportunities.
- Monitor payer, reimbursement, and regulatory trends affecting Specialty Pharmacy and Home Infusion services and recommend strategic actions.
- Build and maintain senior-level relationships with payer contracting teams, provider relations departments, and specialty pharmacy networks.
- Expand payer participation, specialty pharmacy access, and market opportunities across Pure Infusion’s 14-state footprint.
- Collaborate with Revenue Cycle, Pharmacy Operations, Clinical Leadership, Credentialing, Compliance, Finance, Legal, and Business Development to ensure successful contract implementation and operationalization.
- Resolve complex payer contract, reimbursement, and operational issues, ensuring negotiated terms are effectively translated into billing and clinical workflows.
- Drive continuous improvement in contracting processes, negotiation tools, reporting, and contract management practices.
- 6–8 years of experience in payer contracting, managed care, Specialty Pharmacy, Home Infusion, or healthcare reimbursement.
- Demonstrated experience negotiating commercial and government payer contracts.
- Experience evaluating reimbursement methodologies and financial contract performance.
- Experience working collaboratively with pharmacy, clinical, operational, and finance teams.
- Strong expertise in Specialty Pharmacy reimbursement, financial analysis, negotiation, relationship management, and project management.
- Ability to meet U.S. employment eligibility requirements.
- Bachelor’s degree in Business, Healthcare Administration, Finance, Pharmacy, or a related field (or equivalent professional experience).
- Relevant managed care or contracting certification (e.g., CPAR, CMRS) — a plus but not required.
No licensure is required for this role. Relevant managed care or contracting certifications (e.g., Certified Payer Auditing and Reimbursement — CPAR; Certified Medical Reimbursement Specialist — CMRS) are considered a plus.
PHYSICAL REQUIREMENTS- Prolonged periods of sitting and working on a computer.
- Must be able to lift up to 15 pounds occasionally.
- Periodic travel may be…
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