Job Information
BrightSpring Health Services DIRECTOR, PAYOR RELATIONS AND CONTRACTING in LOUISVILLE, Kentucky
Our Company
PharMerica
Overview
Responsible for strategic development and execution of PBM and 3rdParty Payor contracting for PharMerica LTC Pharmacy business units.
Responsibilities
Oversees all Pharmacy PBM and 3rdParty Payor contracting process for LTC PharMerica business unit. This includes Medicare Part D, Commercial and Managed Medicaid.
Manage and negotiate national 3rdParty Payor and PBM contracts to ensure company’s objectives are met in a timely manner.
Develops and executes a dynamic and strategic PBM and Payor strategy to support annual plan and business objectives. This includes effectively managing GER, BER and reconciliation processes.
Responsible for financial oversight of the department including underwriting and auditing of all potential and existing contracts while working collaboratively with financial and operational leaders.
Analyzes applicable Pharmacy PBM and 3rdParty Payor contracts, associated documentation and proposed fees, and negotiates financial terms of contracts.
Oversees all components of contracting process, database management and communication to all business owners.
Participates and effectively manages all cross-functional needs to efficiently support the flawless implementation of new contractual relationships and collaboration with all appropriate internal stakeholders.
Provides market segment performance and feedback to the leadership team.
Significant understanding of the PBM and 3rdPayor landscape, national and regional, and reimbursement processes across LTC Pharmacy business segment.
Directs and performs analysis necessary to ascertain PBM and Payor compliance with contractual obligations.
Excellent communication, executive presence, and interpersonal skills with demonstrated proficiency to advance business objectives cross-functionally.
Understanding and working knowledge of PBM and 3rdParty Payor program metrics, methodologies and recoupment processes.
Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Qualifications
Education/Learning Experience
Required: Bachelor’s degree in business administration, Life Sciences or related field
Desired: MBA
Work Experience
Required: Ten (10) or more years of related PBM
Required: Ten (10) or more years of health-plan contracting or provider experience
Desired: Fifteen (15) or more years of management experience in healthcare setting
Skills/Knowledge
Required: Strong analytical, communication, management and relationship skills
Required: Advanced knowledge of Microsoft Office products (Excel, Word, Powerpoint), Power BI or SAS
Licenses/Certifications
Required:
Desired:
Travel
Required: 25% (Trade Shows, Association meetings, etc.)
Desired
About our Line of Business
PharMerica, an affiliate of BrightSpring Health Services, is a full-service pharmacy solution providing value beyond medication. PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations, and post-acute care organizations. PharMerica is one of the nation's largest pharmacy companies, offering unmatched company culture, employee development, and advancement opportunities. For more information, please visitwww.pharmerica.com. Follow us onFacebook (https://www.facebook.com/PharMericaCorp) ,LinkedIn (https://www.linkedin.com/company/pharmerica) , andX (https://x.com/PharMericaCorp) .
ALERT: We are aware of a scam whereby imposters are posing as employees from our company. Beware of anyone requesting financial or personal information. We take pride in creating a best-in-class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card, driver’s license, bank information, or payment for work equipment, etc.) from you via text or email. If you are suspicious of a job posting or job-related email mentioning our company, please contact us at TalentAcquisition@brightspringhealth.com .
Click here (https://www.brightspringhealth.com/careers/frequently-asked-questions/) for additional FAQ information.
Job LocationsUS-KY-LOUISVILLE
ID 2025-163115
Line of Business PharMerica
Position Type Full-Time