Pharmacy Payer Relations & Net Strategy Mgr

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Since 1983, Johns Hopkins Care at Home has provided safe, high-quality, and cost-effective care in the home and community. Our team links care across multiple sites for patients, families, and colleagues in an effort to restore, maintain, and promote health and reduce the effects of disease and disability. As part of Johns Hopkins Medicine, we have access to the most innovative treatments and the latest research, and we emphasize education and training among our team members. We also collaborate with doctors, nurses, and specialists throughout Johns Hopkins Medicine to ensure continuity of your care.

Reporting to the Director of Specialty Pharmacy, the Pharmacy Payer Relations and Network Strategy Manager is responsible for developing and executing strategic initiatives to secure and optimize specialty pharmacy network access across commercial, Medicare, and Medicaid payers. This role focuses on aligning payer partnerships with broader health system goals, leveraging data analytics to inform strategy, and ensuring compliance with credentialing and performance standards.

Essential Functions

Strategy and Execution

• Develop, implement, and manage a comprehensive, market-based payer strategy to ensure specialty pharmacy network participation
• Ensure the alignment of payer programs with the health system's strategic business initiatives
• Monitor and assess network requirments, ensuring compliance with payer standars, credentialing and performance metrics
• Support contract negotiations with commercial insurers, Medicare/Medicaid, and PBMs to optimize metwork access and reimbursement

Account Management and Payer Relations

• Establish relationships with key payer stakeholders, ensuring strong partnerships that drive retention and access with a focus on specialty pharmacy
• Conduct regular business reviews with payers to assess performance, contract adherence, and strategic opportunities
• Provide subject matter expertise within the credentialing and re-credentialing process for payer contracts and payer network participation
• Evaluate and respond to Requests for Proposals (RFPs) and Requests for Information (RFIs) to secure new payer partnerships
• Advocate for fair access to specialty pharmacy networks by engaging in payer discussions, policy reviews, and appeals processes
• Track payer polcies and formulary changes, assessing their impact on specialty pharmacy services and patient access
• Serve as a point of contact for payer-related escalations, resolving access barriers and reimbursement disputes

Analytics

• Utilize data to support strategic decision-making, network expansion, and network maintenance
• Provide data-driven insights to payers and internal stakeholders
• Communicate the specialty pharmacy's value proposition and identify areas for data alignment
• Collaborate with revenue cycle and billing teams to analyze and optimize reimbursement and address payer-related issues

Care At Home - Who we are: https://youtu.be/FJpe-cbaA7g?si=ula_iBAkPPb7PTPm (Copy and paste into browser)

What Awaits You?

• Career growth and development
• Diverse and collaborative working environment
• Competitive Benefits Package
• Tuition Assistance

Minimum Qualifications:

• Graduation from an accredited College of Pharmacy resulting in Pharm. D. or BS degree. MBA, MHA,or equivalent preferred.
• Current licensure as a pharmacist in the State of Maryland required.
• Minimum three to five years of experience in specialty pharmacy, managed care, or payer relations
• Experience in pharmacy contracting, payer negotiations, or network access strategies
• Strong knowledge of drug reimbursement models, PBMs, and health system pharmacy operations

Salary Range: Minimum 51.02/hour - Maximum 84.26/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.