CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.
Job Details:
The Manager, Payor Relations is responsible for driving strategic partnerships and ensuring operational excellence across the healthcare payor landscape. This role develops and maintains collaborative relationships with state health plans, pharmacy benefit managers (PBMs), and national payors to secure and manage contractual agreements that advance organizational growth, compliance, and sustainability.
Responsibilities
· Establish and maintain payor relationships before and after contracting; this includes managing payor contracts and required reporting
· Lead payor contract negotiations for new and renewal contracts, ensuring favorable terms and competitive reimbursement rates
· Work collaboratively with operations, billing, clinical, and marketing teams to ensure alignment of payor strategies with the overall business objectives.
· Ensure that payor agreements comply with state and federal regulations, industry standards, and accreditation
· Provide leadership, guidance, and manage direct reports
· Oversee credentialing processes to ensure timely and accurate provider enrollment
· Assist management team and participates in other duties to meet company objectives as directed by leadership
Required:
· Bachelor’s degree in Healthcare Management, Business Administration, or a related field (or equivalent experience).
· Minimum of 5 years of experience in payor relations, payor contract management, or related functions within specialty pharmacy, infusion therapy, or healthcare services.
· Proven experience negotiating and managing complex payor contracts with regional and national health plans or PBMs.
· Strong communication and relationship-building skills across internal and external stakeholders.
Preferred:
· Supervisory or team leadership experience.
· Knowledge of accreditation requirements (e.g., ACHC, URAC, or Joint Commission).
· Familiarity with reimbursement models, payer credentialing systems, and regulatory compliance processes.
CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.
CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.
