Director of Payor Contracting Infusion

Director of Payor Contracting Infusion

Location: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement Alternate locations may be considered.

The Director Payor Contracting directs the enterprise payor contracting strategy for an infusion pharmacy organization and ensures that standardized and approved processes are utilized for payor relationship management, contract negotiation, network participation strategy, and reimbursement optimization across commercial, Medicare, Medicaid, and employer-sponsored plans, with a primary focus on medical benefit contracting and site-of-care infusion models.

How you will make an impact:

• Develops and leads a comprehensive contracting strategy aligned with growth goals across home infusion, ambulatory infusion centers (AICs), and site-of-care optimization strategies within the medical benefit.
• Serves 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.
• Leads 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.
• Oversees 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.
• Partners 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.
• Acts 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.
• Leads, mentors, and develops a team of payor contracting professionals and contract managers, including oversight of credentialing, licensure, and audit readiness functions tied to infusion contracts.
• Ensures 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 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 any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

• MBA/advanced degree with experience in infusion services, home infusion, ambulatory infusion centers (AICs), and strong understanding of Medicare Part B, Medicaid, and commercial medical benefit reimbursement preferred.
• Proven experience negotiating with national and regional health plans for infusion services, including site-of-care strategy, utilization management, and complex medical benefit contracting preferred.
• Deep understanding of infusion reimbursement methodologies (ASP, AWP, WAC, per diem, case rates) and their impact on margin, operations, and clinical delivery models preferred.
• Experience supporting credentialing, licensure, Board of Pharmacy requirements, audit readiness, and compliance with CMS and health plan guidelines within infusion contracting preferred.
• Demonstrated ability to lead larger contracting teams and manage complex, longer-cycle negotiations and payer escalations preferred.
• Strong cross-functional leadership, problem-solving, and executive communication skills with experience influencing senior stakeholders and driving strategy in fast-paced, complex environments preferred.