Payer Contracting Manager, Home Infusion

Job not on LinkedIn

🕒 July 17

🇺🇸 United States – Remote

💵 $103.9k - $173.1k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

👻 Ghost score 37%

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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Provide guidance to stakeholders on payer contract information • Build and maintain a knowledge base of home infusion contract reimbursement information • Advise health system partners on home infusion pharmacy contracting • 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, 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 loaded accurately • 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 • Oversee payer change management, prioritization, risk mitigation, and cross-functional coordination • Provide executive oversight for payer audits and identify systemic improvement opportunities • Define contracting-pricing review cadences and support best practices • Serve as a trusted advisor to client executives and internal leadership • Translate payer performance into strategic insights and recommendations • 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 • 8+ years of payer or contract management experience in specialty pharmacy and/or infusion therapy required • Advanced knowledge of health insurance plans, including Managed Care Organizations, PPO, POS, Self-Funded, TPAs, and providers at financial risk • 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 building relationships with regional and national payors and health system clients in managed care and leadership • 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 • For home-based work, cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload

🏖️ Benefits

• Annual bonus plan eligibility • Medical, vision, and dental benefits starting on day one • 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 • Tobacco-free policy • Reasonable accommodation support for the online application process