Director of Payor Contracting - Infusion

Location Field‑based role enabling associates to primarily operate in the field, traveling to client sites or designated locations as required. Occasional office attendance for meetings or training is expected. Candidates must be within a reasonable commuting distance from the posting location(s) unless a lawful accommodation is granted. The company adheres to a hybrid workforce strategy, requiring onsite presence at least once per week unless otherwise specified by the hiring manager. Key Responsibilities Develop and lead a comprehensive contracting strategy aligned with growth goals across home infusion, ambulatory infusion centers, and site‑of‑care optimization strategies within the medical benefit. Serve as a strategic advisor to executive leadership on health plan contracting trends, medical benefit reimbursement risk, site‑of‑care shifts, and evolving regulatory/CMS considerations impacting infusion services. Lead complex negotiations with national and regional health plans and government payors, including reimbursement methodologies (e.g., ASP, AWP, WAC, per diem, case rates), utilization management requirements, and infusion‑specific carve‑outs. Oversee contract modeling, financial impact analysis, approval governance, and ongoing performance monitoring to ensure contracts meet margin, growth, and operational feasibility given the complexity and longer lifecycle of infusion services. Partner with finance, operations, and clinical teams to evaluate reimbursement methodologies and ensure contracts support site‑of‑care delivery models, nursing services, prior authorization workflows, and patient access timelines. Act as the primary liaison between contracting and internal stakeholders including operations, revenue cycle, clinical leadership, legal/compliance, and reporting, ensuring infusion contracts are executable across clinical and billing workflows. Lead, mentor, and develop a team of payor contracting professionals and contract managers, including oversight of credentialing, licensure, and audit readiness functions tied to infusion contracts. Ensure contracting activities align with federal and state regulations, CMS requirements, and health plan audit expectations, including compliance with Medicare Part B, Medicaid, and site‑of‑care guidelines. Minimum Requirements Requires a Bachelor’s degree and a minimum of 10 years of experience in payor contracting, reimbursement, or managed care within specialty pharmacy, infusion services, PBM, or health plan environments, including demonstrated success leading complex national and regional negotiations and proven people leadership experience; or an equivalent combination of education and experience. Preferred Skills, Capabilities, And Experience MBA or advanced degree with experience in infusion services, home infusion, ambulatory infusion centers, and strong understanding of Medicare Part B, Medicaid, and commercial medical benefit reimbursement. Proven experience negotiating with national and regional health plans for infusion services, including site‑of‑care strategy, utilization management, and complex medical benefit contracting. Deep understanding of infusion reimbursement methodologies (ASP, AWP, WAC, per diem, case rates) and their impact on margin, operations, and clinical delivery models. Experience supporting credentialing, licensure, Board of Pharmacy requirements, audit readiness, and compliance with CMS and health plan guidelines within infusion contracting. Demonstrated ability to lead larger contracting teams and manage complex, longer‑cycle negotiations and payer escalations. Strong cross‑functional leadership, problem‑solving, and executive communication skills with experience influencing senior stakeholders and driving strategy in fast‑paced, complex environments. Benefits We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health