Payer Contracting Manager, Home Infusion

Job not on LinkedIn

🔥 18 minutes ago

🇺🇸 United States – Remote

💵 $103.9k - $173.1k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Provide guidance to stakeholders on payer contract information • Build and maintain a knowledge base of home infusion contract reimbursement information • Advise CarePathRx health system partners using payer contracting subject matter expertise • Serve as liaison and strategic partner to client leadership and internal stakeholders • Develop payer priorities for securing contracts • Review payer contracts and amendments and provide recommendations • Evaluate proposed per diem and drug rates against benchmarks • Guide health system implementation of home infusion pharmacies • Align processes with implementation timelines, including payer credentialing applications • Provide consultation, education, and training on contract requirements, reimbursement methodologies, rates, and policies • Coordinate cross-functionally to ensure contract, amended-rate, and payer information is accurately loaded • Maintain benchmark-rate and managed-care-term knowledge bases • Manage payer contracts and amend reference materials • Resolve payer processing and contract-load issues with internal and external teams • Set strategic direction for payer contract management and contract operationalization • Oversee payer change management, prioritization, risk mitigation, and cross-functional coordination • Provide executive oversight for payer audits and identify systemic improvement opportunities • Define review cadences and best practices for contracting pricing optimization • Advise client executives and internal leadership with strategic payer-performance insights • Foster cross-functional relationships for payer engagement strategies

🎯 Requirements

• 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, reimbursement, regulatory requirements, and financial controls • Knowledge of HIPAA guidelines and 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 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 PowerPoint • Experience with CPR+, CareTend, and HCN EMR systems preferred • Strategic, analytical mindset with ability to balance long-term vision and operational outcomes • For home-based work, internet connection must be through a cable broadband or fiber optic provider with speeds of at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Remote work arrangement • Cable broadband or fiber optic internet service with minimum speeds of 10Mbps download/5Mbps upload for home-based work