Director, Pharmacy Network Contracting & Public Payer Relations

Position Summary

The Director of Pharmacy Network Contracting & Public-Payer Relations reports to the Senior Vice President of Member & Community Relations of the Hemophilia Alliance. This role serves as an advisor and consultant to internal stakeholders, external partners, and member hemophilia treatment centers (HTCs), providing guidance on healthcare policy; 340B drug discount operations; and payer/Pharmacy Benefit Manager (PBM) coverage, utilization management, and reimbursement requirements impacting people living with bleeding disorders.

The Director leads commercial pharmacy, PBM, and government-sponsored payer relations activities to support standardized, high-quality care and timely medication access and delivery. The role collaborates across Hemophilia Alliance departments and with external partners to support operational and clinical best practices, data reporting needs, prior authorization policy, and payer strategy. This position also supports the growth and sustainability of Hemophilia Alliance Network Services (HANS), including member HTC credentialing requirements and pharmacy policy agreements/contracting processes.

This role is well-suited for a mission-driven leader with broad pharmacy and healthcare policy experience who thrives in a fast-moving environment and can flex between detailed analysis and cross-functional project coordination within a virtual, matrixed team.

• Supports the mission of the Hemophilia Alliance: “The Hemophilia Alliance works to ensure member Hemophilia Treatment Centers (HTCs) have the expertise, resources and public support to sustain their integrated clinical and pharmacy services for individuals with bleeding and clotting disorders.”
• Works with and reports through the Director of Member & Community Relations team in identifying opportunities to allow HTCs the ability to dispense or distribute medications to their patients through the development of the Hemophilia Alliance Network Services (HANS) through single case agreements, and insurance payer contract negotiations.
• Leads and optimizes Hemophilia Alliance supported coordinated longitudinal clinical pharmacy operations across member HTCs, aligning workflows that strengthen patient access, care coordination with all levels of care, and service consistency while respecting local HTC practices and regulatory requirements.
• Provides and coordinates clinical reviews received to support the implementation of clinically supportable prior authorization process, including clear clinical rationale and explanation of hemophilia therapy selection (factor and non-factor products) as determined by evidence-based practice, aligned with sustainable provider healthcare reimbursement policies and unincumbered patient access to care.
• Create, implement, and coordinate the HANS credentialing program for pharmacies, including credentialing standards, application and review processes, re-credentialing cadence, issue remediation, quality assurance monitoring, and communication with member HTCs and pharmacy partners to support HANS PBM agreements and contracting processes.
• Partner with credentialing/enrollment contacts and member HTCs to ensure provider/pharmacy enrollment, revalidation, roster accuracy, and directory corrections across payers to protect patient access and HTC network access.
• Works collaboratively to gather data from members in conjunction with Member and Community Relations team members, the Payer Pricing Data Analyst, and Director Data Engineering & Operations to support HANS and Hemophilia Alliance payer initiatives ensuring data accuracy and timely submission.
• Support contract development with payers and PBMs through HANS, as well as member HTC reimbursement with government sponsored payers.
• Become the in-house Alliance subject matter expert (SME) for Medicare and Medicaid, monitoring policy updates and translating requirements into network workflows for coverage, authorizations, billing guidance, and payer communications as needed to support member HTCs and patient access.
• Monitor payer coverage criteria and utilization management requirements (e.g., prior authorization, reauthorization…