SVP Managed Care Team

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. SVP Managed Care Team Full Time US 3 days ago Requisition ID: 1243 Job Title: Senior Vice President (SVP), Managed Care – Specialty Pharmacy Reports to: Chief Executive Officer / President of Specialty Pharmacy (or equivalent C-suite leader) Location: [Remote / Hybrid / Specific city – customize as needed] Travel: Up to 25–40% for payer meetings, conferences, and key account engagements Position Summary The Senior Vice President of Managed Care leads the organization’s payer strategy, contracting, network access, and reimbursement optimization for a specialty pharmacy. This executive role is responsible for securing and managing high-value relationships with health plans, PBMs, TPAs, employers, and government programs to maximize patient access to specialty therapies, optimize reimbursement, and drive profitable growth. The SVP sets the strategic direction for the Managed Care team, ensures competitive contract terms, oversees credentialing and network participation, and partners cross-functionally to align payer strategies with clinical, operational, and financial goals. Key Responsibilities Strategic Leadership & Payer Strategy Develop and execute a comprehensive managed care strategy that expands network participation, improves formulary positioning, and secures preferential rates/rebates for specialty medications across commercial, Medicare, Medicaid, and other lines of business. Identify priority payers and channels; lead multi-year contracting roadmaps aligned with pipeline therapies, limited-distribution drugs, and growth objectives. Monitor industry trends (biosimilars, value-based arrangements, site-of-care shifts, 340B implications) and proactively adapt strategies. Contracting & Negotiation Lead or oversee negotiation of payer contracts, amendments, fee schedules, and performance guarantees, focusing on favorable reimbursement methodologies, prior authorization processes, and administrative terms. Evaluate contract performance, identify underperforming agreements, and drive renegotiations or terminations as needed. Collaborate with legal, finance, and revenue cycle teams on contract language, rate modeling, and compliance. Network Access, Credentialing & Operations Support Oversee payer credentialing, re-credentialing, and network participation processes to ensure timely access and minimize disruptions. Partner with operations, intake, billing/collections, and clinical teams to implement contract requirements, train staff on reimbursement rules, and resolve payment variances or denials. Support limited-distribution network (LDN) strategies and manufacturer access programs in coordination with channel/partnership teams. Team Leadership & Cross-Functional Collaboration Lead, mentor, and develop the Managed Care team (directors, managers, contract specialists, analysts). Foster strong partnerships with Sales/Business Development, Clinical, Pharmacy Operations, Finance, Compliance, and Manufacturer Relations teams. Represent the organization in executive-level payer meetings, industry forums, and RFP responses. Performance, Analytics & Compliance Establish KPIs for contract performance, access rates, reimbursement yield, days in AR related to managed care, and team productivity. Ensure all activities comply with applicable regulations (e.g., Medicare/Medicaid rules, state insurance requirements, accreditation standards such as URAC/ACHC). Provide regular reporting and insights to the executive team on portfolio performance, risks, and opportunities. Qualifications Education Bachelor’s degree required (Pharmacy, Business, Healthcare Administration, or related field). Advanced degree (MBA, MHA, PharmD, or equivalent) strongly preferred. Experience 12–15+ years of progressive experience in managed care, payer contracting, or specialty pharmacy/PBM/health plan environments. At least 5–7 years in senior leadership roles (Director/VP level or higher) with direct responsibility for payer strategy and contracting. Proven track record negotiating complex specialty pharmacy or infusion contracts, optimizing reimbursement, and expanding network access. Deep knowledge of specialty drug reimbursement, limited-distribution networks, prior authorization processes, Medicare Part D/B, Medicaid, commercial plans, and value-based or risk-sharing arrangements. Experience with 340B, manufacturer channel strategies, or health-system specialty pharmacy preferred. Exceptional negotiation, relationship-building, and executive presence. Strong analytical and financial modeling skills related to rate structures, margin impact, and contract performance. Ability to lead in a matrixed, high-growth environment and influence without direct authority. Excellent communication skills (written, verbal, and presentation) for both internal stakeholders and external payer executives. High integrity and commitment to compliance and ethical contracting practices. #J-18808-Ljbffr Hpcinfusion