Description
Baptist Health is looking for Director, Pharmacy Payer Access Strategy & Contracting to join our Pharmacy Team. This may be a remote position.
The Director, Pharmacy Payer Access Strategy & Contracting is responsible for driving growth and profitability for Baptist Health Pharmacy through effective contract administration.
This position requires a well-connected leader with experience onboarding new pharmacy payers and operationalizing payer contract requirements.
Responsible for developing and implementing a business development strategy for the pharmacy payer organization sector driving revenue enhancement through partnerships with pharmacy payers, capitalizing on the geographic scope of Baptist Health and developing value propositions for the payer community.
Seeks opportunities for Baptist Health to engage in population health management opportunities with payers that provide system opportunities to maximize revenue growth.
Maximizes ambulatory and specialty pharmacy network access to expand internal pharmacy dispensing capabilities for Baptist Health patients.
Provides strategic leadership, financial and administrative oversight of contracting with pharmacy payers working directly with Baptist Health pharmacy and managed care leadership.
Responsibilities include establishing contracting goals and strategies, negotiating and supporting all contracts with pharmacy payers, and maintaining oversight of provider manual changes to ensure compliance.
The scope of the Director, Pharmacy Payer Access Strategy & Contracting role includes community / retail and specialty contracting for current and new community pharmacies and central pharmacy services center.
Leads pharmacy payer credentialing and contract modeling, ensuring payer compliance with contract terms and payment rates, and maintaining positive pharmacy payer relations.
Ensures that the privacy and confidentiality of patient information is maintained. Manages the facilitation and implementation of activities related to the privacy and security of protected health information (PHI).
Requirements
- Master’s degree in business or health related field. PharmD desired.
- Minimum of five (5) years of experience working in pharmacy payer performance and contract administration.
- Minimum of three (3) years handling complex payer contracts including community / retail pharmacy, specialty pharmacy, infusion, and 340B.
- Knowledge of reimbursement dynamics across pharmacy and medical benefits.
- Demonstrated evidence managing performance targets.
Pharmacy Contracting, Pharmacy Payer Strategy, Pharmacy Payer Contracting, Pharmacy Leadership
Baptist Health is an employer.
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