Payer Development Manager

Pure Infusion Suites is a fast-growing healthcare start-up, recognized as the fastest-growing company in Utah as of October 2024. Our success comes from our remarkable team, shared values, and a supportive culture that shows in every interaction, whether with patients in our clinics or with insurance companies and vendors at our corporate headquarters. If you are detail-oriented, self-directed, and passionate about ensuring claims are processed quickly and accurately, this could be the perfect role for you.

OUR CORE VALUES

People-obsessed Position Summary The Contract / Payer Development Manager is responsible for supporting and advancing payer contracting initiatives while maintaining ownership of assigned payer relationships. This role manages contract life cycle process, implements leadership strategy, tracks & reports on team metrics, and oversees contract implementation processes to ensure payer agreements are financially optimized and operationally executable. The Manager serves as a bridge between department leadership and payer account execution, translating strategic objectives into actionable contracting initiatives. This role also supervises the Contract Implementation Specialist / Analyst to ensure contract terms, fee schedules, and payer resources are accurately implemented and maintained across the organization. In addition to contracting leadership, the Manager directly manages select payer relationships, supporting negotiations, performance analysis, and relationship development in alignment with departmental objectives. Core Areas of Responsibility Support execution of payer contract strategy across assigned markets and payer portfolios. Lead or support contract negotiations, amendments, and renewals in coordination with the Director of Payer Development. Prepare negotiation strategies using financial and operational data, including reimbursement performance, drug margin analysis, utilization trends, and operational impact assessments. Identify opportunities to improve contract value through rate renegotiations, biosimilar carve-outs, drug reimbursement improvements, site-of-care initiatives, and contract language optimization. Coordinate internal contract approval and signature processes while managing payer communications throughout negotiations. Payer Account & Relationship Management Serve as the primary relationship owner for assigned payer accounts. Manage the full lifecycle of payer relationships including contract negotiations, amendments, renewals, performance monitoring, and relationship development. Maintain strong, professional partnerships with payer representatives and ensure consistent engagement across assigned accounts. Identify opportunities to strengthen payer relationships and expand market access, reimbursement performance, or utilization. Support Account Managers by providing guidance on negotiation strategy, contract analysis, and payer engagement approaches. Contract Implementation Oversight Oversee contract implementation activities to ensure payer agreements are accurately operationalized across internal teams. Directly manage the Contract Implementation Specialist / Analyst responsible for contract tagging, fee schedule management, and contract resource development. Ensure contract updates, fee schedule changes, and policy modifications are accurately reflected within contract management systems and internal operational resources. Support internal teams in interpreting payer contract language and operational requirements. Data Analysis & Contract Performance Conduct financial and operational analysis related to payer contracts, including fee schedule comparisons, drug reimbursement performance, utilization trends, and contract amendment impacts. Prepare analyses and reporting that support negotiation strategies and leadership decision-making. Monitor contract performance and identify opportunities for renegotiation, optimization, or operational improvements. Provide data insights and reporting to the Director and Vice President of Payer Development. Program Execution & Market Development Support execution of payer development initiatives including redirection programs, contract renegotiation strategies, market access expansion, and narrow network participation. Monitor program outcomes and performance metrics to ensure alignment with financial and operational objectives. Identify opportunities to strengthen payer partnerships and support growth initiatives across markets. Cross-Functional Collaboration Serve as a key operational liaison between Payer Development and internal departments including Revenue Cycle, Intake & Operations, Clinical Leadership, Credentialing, Compliance, and Finance. Closely collaborate with the Credentialing & Compliance Manager Ensure payer contract terms and requirements are clearly communicated and operationalized across teams. Support resolution of escalated payer operational issues related to claims, credentialing, network status, or authorization processes. Process Improvement & Operational Development Identify opportunities to improve payer contracting workflows, negotiation preparation processes, and contract implementation procedures. Support development and maintenance of internal resources including contract playbooks, negotiation frameworks, fee schedule management tools, and contract performance reporting. Contribute to building scalable processes that support organizational growth and increasing payer contract complexity. Key Responsibilities Manage assigned payer relationships and contracting initiatives. Lead or support contract negotiations, amendments, and renewals. Oversee contract implementation and fee schedule management processes. Supervise the Contract Implementation Specialist / Analyst. Conduct contract performance analysis and financial impact assessments. Support payer development programs and market access initiatives. Ensure payer requirements are communicated and operationalized across internal teams. Identify opportunities for contract optimization and process improvement. Required Knowledge and Skills Strong knowledge of payer contracting structures, reimbursement methodologies, and healthcare operations. Experience supporting or leading payer negotiations and contract strategy development. Advanced analytical ability with experience interpreting contract, fee schedule, and utilization data. Strong Excel proficiency including pivot tables, financial analysis, and data modeling. Excellent relationship management and communication skills. Strong organizational skills with the ability to manage multiple complex initiatives simultaneously. Collaborative mindset with strong cross-functional influence. Education & Experience Requirements 6–8 years of experience in payer contracting, payer development, healthcare operations, or related fields. Demonstrated experience supporting or leading payer negotiations and contract strategy. Experience performing financial and contract analysis using Excel or similar tools. Experience working cross-functionally with operational and clinical teams. Ability to meet U.S. employment eligibility requirements. The pay range for this role is: 85,000 - 105,000 USD per year (45010 Sandy) #J-18808-Ljbffr AleraCare