Senior Director, Payor Relations

🕒 5 days ago

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Soleo Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🧘 Wellness

Healthcare Insurance • Pharmaceuticals • Wellness

Soleo Health is a specialty pharmacy company that goes beyond simply filling prescriptions by providing personalized patient experiences and access to specialized medications and infusion therapies. They offer treatment in patients' homes, in providers' offices, or at one of their many nationwide infusion centers. Soleo Health specializes in treating complex and ultra-rare diseases with a focus on improving patient quality of life and optimizing health outcomes. They work closely with patients, providers, pharmaceutical manufacturers, payors, and health systems to deliver high-cost therapies, demonstrating value through real-world outcome data. Soleo Health is recognized for its clinical excellence and dedication to patient care, and offers nationwide services, including an online portal, Soleo Connect®, for real-time communication.

📋 Description

• Formulate and oversee the implementation of comprehensive regional and national Payor contracting and network management strategies. • Drive the achievement of contracted sales goals and enhance market share and profitability. • Lead the identification, development, negotiation, and management of Payor Relations agreements to ensure competitive and sustainable growth. • Initiate and guide the launch of innovative Payor relations programs and contracts, collaborating with senior internal stakeholders including operations, finance, and Regional Vice Presidents. • Oversee detailed financial analyses of Payor contracts to assess the earnings impact of new contracts, as well as renewals and material network changes. • Manage budget projections for pricing and assess financial performance of payor contracts. • Ensure Payors are reimbursing Soleo at the contracted rates and that reimbursement is timely. • Enhance Soleo’s contracting strategy to maximize value (where applicable) using national contracts with chain codes vs. individually contracted pharmacies. • Serve as the primary executive contact for major external partners, including hospitals, Payor organizations, and manufacturers. • Build and maintain strategic relationships to bolster business objectives. • Oversee the design and implementation of advanced sales training programs that focus on Payor relations, contract comprehension, opportunities, and associated risks. • Monitor and analyze market trends and contractual activities to identify and seize opportunities for new or expanded Payor agreements. • Lead the development of performance-based contracting models that reflect the latest in healthcare industry advancements and match organizational goals (i.e., Soleo’s participation in limited payor networks). • Maintain and update the company's strategy in response to healthcare legislation changes. • Act as a subject matter expert to guide Payor Relations policies and practices. • Manage the creation and ongoing updates of departmental policies to ensure compliance with regulatory, operational, and organizational standards. • Partner with Revenue Cycle Management team to defend Soleo’s interests in payor audits. • Manage the creation and ongoing updates of departmental policies to ensure compliance with regulatory, operational, and organizational standards. • Completes all necessary managerial tasks for direct reports including hiring, training, addressing performance issues, developing team goals and objectives, performance reviews, conflict resolution, and strategic planning.

🎯 Requirements

• Bachelor’s degree in a related field such as business administration, economics or finance • Minimum of 10 years in Payor Relations and Contracting • Significant leadership experience in complex healthcare environments. • High school diploma (or equivalent) required. • Advanced degrees such as an MBA or Juris Doctorate preferred. • Strong communication, negotiation, and leadership skills. • Proven track record of leading high-performing teams and effectively managing senior-level projects and initiatives. • Exceptional capability in analyzing complex data, identifying strategic insights, and employing them to improve business performance and operational efficiencies. • Expertise in developing and delivering strategies and business plans to a variety of stakeholders, including executive leadership, board members and external partners. • Operates effectively and successfully in fast-paced high growth environment. • Capable of managing multiple, high-stakes projects in parallel with one another. • Willingness and ability to travel extensively, often exceeding 50% of the time, to meet business needs.

🏖️ Benefits

• Competitive Wages • 401(k) with a Match • Referral Bonus • Paid Time Off • Great Company Culture • No Weekends or Holidays • Paid Parental Leave Options • Affordable Medical, Dental, & Vision Insurance Plans • Company Paid Disability & Basic Life Insurance • HSA & FSA (including dependent care) Options • Education Assistance Program