Contracting & Licensing Specialist - Home Infusion Pharmacy & Infusion Suites

Specialties: Multi-State Operations | Pharmacy Licensing | Insurance Contracting | Payer Enrollment Employment Type: Full-Time Job Summary We are seeking a highly experienced, detail-oriented, and proactive Contracting & Licensing Specialist to join our growing home infusion and specialty pharmacy organization. Our company provides specialized infusion therapies through home infusion services and outpatient infusion suites, with operations and expansion initiatives across all 50 U.S. states and Washington, D.C. The ideal candidate will have extensive experience in multi-state pharmacy licensing, healthcare regulatory compliance, insurance contracting, payer enrollment, credentialing, and ongoing contract maintenance. This position plays a critical role in ensuring our pharmacy and infusion suites maintain appropriate licenses, regulatory approvals, payer contracts, and provider participation agreements to support uninterrupted operations and nationwide growth. Key Responsibilities 1. Multi-State Pharmacy Licensing & Regulatory Compliance Manage and maintain pharmacy licenses, nonresident pharmacy permits, and applicable infusion-related licenses across all 50 states and Washington, D.C. Prepare, submit, and track new license applications, renewals, amendments, and regulatory filings. Coordinate licensing requirements with state Boards of Pharmacy, Departments of Health, and other regulatory agencies. Maintain an organized licensing database with renewal deadlines, regulatory requirements, and application statuses. Monitor changes in state and federal regulations affecting home infusion pharmacies, specialty pharmacies, and infusion suites. Coordinate required inspections, regulatory documentation, and responses to licensing inquiries. Support licensing and regulatory requirements for new infusion suite locations and geographic expansion. Ensure timely renewals to prevent lapses in licenses, permits, and registrations. 2. Insurance Contracting & Payer Network Development Identify, research, and pursue contracting opportunities with commercial insurance plans, Medicare Advantage organizations, Medicaid programs, and managed care organizations. Prepare and submit new payer participation applications for home infusion pharmacy and infusion suite services. Manage the full payer contracting process, from initial outreach through contract execution and network activation. Negotiate reimbursement rates, fee schedules, and contractual terms with insurance payers. Maintain and renew existing payer contracts, ensuring continued network participation and identifying opportunities to expand coverage across multiple states. Maintain relationships with insurance payer representatives, provider relations departments, and contracting teams. Track contracting applications, outstanding requirements, payer follow-ups, and approval timelines. Coordinate contract amendments, location additions, provider updates, and changes in company information. Manage enrollment and revalidation processes with Medicare, Medicaid, and commercial insurance plans. Maintain accurate provider and facility information in CAQH, PECOS, NPPES, and other applicable enrollment systems. Coordinate credentialing requirements for pharmacies, infusion suites, healthcare providers, and clinical personnel. Ensure all payer credentialing documentation, certifications, and enrollment records remain current. Resolve enrollment discrepancies, application denials, and payer participation issues. Work with internal departments to ensure new service locations and providers are appropriately enrolled before services are billed. 4. Contract & Compliance Management Maintain a centralized database of licenses, payer agreements, reimbursement terms, credentialing records, and renewal deadlines. Monitor payer agreements for expiration dates, regulatory changes, and contract compliance requirements. Coordinate with billing, revenue cycle, operations, and leadership teams to resolve contracting and enrollment-related issues. Assist in addressing out-of-network reimbursement challenges and identifying opportunities to improve payer participation. Support accreditation-related documentation, including ACHC, URAC, or other applicable requirements. Develop tracking systems, reporting tools, and standardized workflows to improve efficiency and accountability. Provide regular status reports to management on licensing, contracting, credentialing, and expansion initiatives. Qualifications Required: 3-5 years of experience in healthcare contracting, pharmacy licensing, provider enrollment, or credentialing. Strong knowledge of multi-state pharmacy licensing requirements and nonresident pharmacy permits. Experience working with commercial insurance plans, Medicare, Medicaid, and managed care organizations. Demonstrated ability to manage payer applications, contracting processes, and insurance network participation. Familiarity with state Boards of Pharmacy and healthcare regulatory agencies. Excellent organizational skills and ability to manage multiple applications and deadlines simultaneously. Strong written and verbal communication, negotiation, and follow-up skills. Ability to work independently, take ownership of projects, and meet established deadlines. Strongly Preferred: Direct experience with home infusion pharmacy, specialty pharmacy, ambulatory infusion centers, or physician office infusion suites. Prior responsibility for pharmacy licensing across multiple U.S. states. Established experience working with national and regional health insurance payers. Knowledge of pharmacy and medical benefit reimbursement structures for infusion therapies. Experience with payer network development, contract negotiations, and supporting healthcare service expansion into new states. Familiarity with NCPDP, NPI, Medicare/Medicaid enrollment, and payer credentialing systems. What We Are Looking For We are seeking a results-driven specialist who understands how to obtain and maintain licenses, secure new insurance contracts, and expand payer network participation. The successful candidate will be highly organized, persistent in following up with insurance companies and regulatory agencies, and comfortable taking full ownership of projects from start to finish. We are particularly interested in candidates who have successfully managed multi-state pharmacy licensing and established new insurance payer contracts, rather than those with credentialing-only experience. What We Offer Opportunity to join a growing specialty pharmacy and infusion services organization. Direct involvement in nationwide expansion and strategic payer network development. Collaborative environment with access to executive leadership. Competitive compensation based on experience and demonstrated expertise. Opportunities for professional growth and increased responsibility. #J-18808-Ljbffr MedRx Infusion