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Payer Relations - Managed Care Director

at CVS Health

Posted: 2/15/2020
Job Reference #: 1179248BR

Job Description

Job Description
The Payer Relations Director has the oversight and management of an assigned book of business including Pharmacy Benefit Managers, Blue Cross Plans, National Insurance Carriers, Regional Health Plans and State Medicaid Plans. This position primary objective is to develop and maintain payer relationships including contract negotiations, contract management and profitability targets specifically related to pharmacy spend and market share. The additional roles and responsibilities of the Regional Director will include strategic account relations, supporting growth in limited/preferred networks, Preferred Part D networks, clinical and enterprise initiatives. The Regional Director will interface with executive officers across the company, including daily / weekly contact with the Sr. Director of Payer Relations, Vice President of Payer Relations, Managers, Directors and Vice Presidents in Legal, Retail Operations, Marketing, Real Estate, Specialty and Merchandising.

The successful candidate will possess the following skills:
- Structured & Logical Thinking: The ability to identify and define business problems and issues, and develop strategic initiatives to move the business forward within their book of business, negotiation skills, analytical, and understanding of financial frameworks to conduct analysis and/or measure success.
- Analytical Rigor: Proven capability conducting and managing quantitative portfolio growth analysis.
Position Expectations:
-Responsible for implementing the company strategy and growing market share within each of his or her clients.
- The Payer Relations Director should be self-directed and identify and define business problems and issues, and develop strategic, analytical, and financial frameworks to conduct analysis and/or measure success.
- Thorough preparation for client meetings is required as is timely follow up on meeting notes, action items and growth opportunities.
-The Payer Relations Director is responsible for having a thorough understanding of the book of business he or she manages at a detailed level, understanding clients’ objectives, growth and areas of opportunity, in order to develop a partnership strategy.
-The Payer Relations Director is required to thoroughly understand each contract he or she manages, including actual performance vs contract and ensures clients adhere to contract language.
-The Payer Relations Director is responsible for conducting and managing quantitative portfolio growth analysis, completing evaluation of client renewals and new business opportunities.
-The Payer Relations Director is responsible for presenting client renewals, new business opportunities, bids/RFPs, etc., to leadership, effectively and succinctly, in a manner that clearly articulates the ask and his or her strategy and recommendation for the deal presented.
- The Payer Relations Director is responsible for ensuring that the Finance and Analytics team has the accurate contracted rates and terms to ensure that budgets and forecasts are accurate and contract reconciliations are created with the correct information.

This role can be based anywhere remotely in the U.S.

Required Qualifications
*Minimum of 5 years of professional work experience within Pharmacy Benefit Management or Retail Pharmacy Industry.
*Minimum of 5 years of experience drafting and negotiating contracts and associated financial frameworks.
*Ability to travel up to 40% of the time.

Preferred Qualifications
* Passion for Health Care: A history of work in the health care industry and an ongoing desire to make one of the world’s strongest health care companies even stronger.
* Powerful Communication: The ability to communicate effectively and succinctly with a diverse range of constituents, both verbally and on paper, and with all levels of an organization. Communicate in an open and honest way that quickly builds trust and respect.
* Team Leadership: Highly developed relationship-building skills to foster effective working relations across the Retail Enterprise.
* Influencing others: Must possess the ability to structure useful guidance around complex and far reaching strategy decisions to influence and guide the decisions made by others.

Bachelors’ Degree or equivalent years of related professional work experience in combination with years education in lieu of a degree.

Business Overview
It’s a new day in health care.

Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.

We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran - we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.

If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.

Application Instructions

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