Senior Director, Payor Contracting - West

The Senior Director of Payor Contracting reports to the Department’s Vice-President of Managed Care Contracting and will be responsible of the management and execution of the Department’s Payor Access and Contracting strategy across the Shields network of health system partners related to specialty pharmacy network contracting.  This is a senior client-service leadership role, and Shields is seeking an experienced healthcare leader to support the department’s execution, growth and development in a fast-paced and dynamic environment. 

Key Responsibilities:

• Plan, develop and execute entrepreneurial and innovative payor access strategy to create and advance specialty pharmacy contract relationships for a regional portfolio of health system partners generally located within the Western half of the United States;
• Represent Shields as the subject matter expert in specialty pharmacy payor access strategy to both senior and executive leadership across a portfolio of Shields health system partners;
• Work in partnership with the of the Payor Contracting leadership team on departmental strategy and planning, the development and implementation of growth initiatives, and-day-to day management of the team;
• In addition to the ownership of a portfolio of Shields partners, the Sr. Director is also expected to be a key contributor in the development and growth of the department’s centralized payor contracting initiatives;
• Develop and meet budgeted payor access targets across the portfolio of supported health system partners;
• Build and manage close relationships with senior managed care and pharmacy leadership across the portfolio of health system partners;
• Align with both internal regional VP’s and external partners on objectives and prioritization;
• Stay current with regulatory, payor, and contractual changes that influence/ impact specialty pharmacy contracting with payors
• Additional responsibilities and expectations include:
  • Driving internal efficiencies via new processes & tools
  • Leverage financial, clinical and claims data to identify new opportunities for our partners;
  • Work with financial analysts to guide and develop models to evaluate payor opportunities for new/ existing arrangements based on evolving reimbursement terms
  • Mentor and develop future team leaders;
  • Identify solutions to non-standard requests and problems;
  • Willingness to do whatever is necessary for the betterment of the Company;
  • Protect organization's value by keeping information confidential;
  • Other duties as assigned.

Experience/Requirements:

• 10+ years of experience and demonstrated success within health system managed care, pharmacy benefit management, or health insurance industries;
• Exceptional communication and relationship management skills. Experience building close relationships with executive-level client counterparts;
• Ability to lead (inspire, manage, develop, and grow) a seasoned team of subject matter experts;
• Demonstrated experience and expertise in framing business issues and inspiring confidence with a variety of internal and external constituents
• Deep understanding of analytics, data and modeling; particularly from a financial perspective to evaluate and drive business decisions;
• Experience with fee-for-service & payment models to evaluate payor contracts Skill in negotiating financial terms and key contractual provisions in contracts with commercial payors and engaging with appropriate internal and external stakeholders to achieve the best outcomes
• Strong business acumen;
• Customer-service oriented;
• Highly organized with the ability to drive strategic results while managing tactical execution
• High-integrity, strict attention to detail, dependable, quality focused, empathetic, good listener/communicator, self-motivated; team player
• Ability to execute strategy in a team environment with the ability to effectively sell change and influence others without direct authority
• Energetic, highly motivated, extreme discretion and confidentiality are essential as this position deals with highly sensitive and private data in a HIPAA compliant environment
• BA/BS degree required; graduate degree preferred

An employee in this position can expect a salary rate between $185,000 and $225,000 plus bonus pursuant to the terms of any bonus plan if applicable. The actual salary will depend on experience, seniority, geographic location, and other factors permitted by law.