Payer Contracting Executive

Job not on LinkedIn

🔥 13 hours ago

🏈 Alabama, Arizona, +25 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote ⚜️ Louisiana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote

💵 $116k - $145k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Executive

👻 Ghost score 0%

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• 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 • Investigate current networks where Lumicera and its partner pharmacies are not in network • Independently outreach to payers to identify credentialing and network requirements and pursue new access opportunities • Establish, monitor, and negotiate pricing and service agreements with payers • Complete credentialing and new contract applications for payer and government clients • Compile supporting documents and reports for payer applications, contracts, and business reviews • Track agreements through the contracting process with internal and external stakeholder input • Meet with payer representatives to determine account management needs and ensure contract compliance • Reenroll and recredential existing payer and government plans, monitoring proactively for coverage gaps • Coordinate projects involving contracts and data needs for master service agreements, shared service agreements, and scope of work documents • Develop relations and contacts with established payers and resolve discrepancies with claims and payments • Review operational and documentation processes for regulatory and payer-contract compliance • Ensure specialty pharmacy reporting requirements are met to maintain network contracts • Analyze, compile, and prepare data analytics and presentations for payer clients and leadership • Provide periodic and detailed reporting of activities and opportunities to leadership • Ensure compliance with applicable state and federal regulations • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree required • Master of Business Administration (MBA) or other graduate degree preferred • Certified Pharmacy Technician or relevant industry 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 • Ability to consistently interact cooperatively and respectfully with other employees

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750!