Director of Payor Contracting – Specialty

Anticipated End Date:

2026-05-01

Position Title:

Director of Payor Contracting – Specialty

Job Description:

Director of Payor Contracting – Specialty

Location: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement Alternate locations may be considered. 

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Director Payor Contracting directs the enterprise payor contracting strategy for a specialty pharmacy organization and ensures that standardized and approved processes are utilized for payor relationship management, contract negotiation, network participation strategy, and reimbursement optimization across commercial, Medicare, Medicaid, and employer-sponsored plans, with a primary focus on pharmacy benefit-driven specialty networks and PBM access.

 

How you will make an impact:

• Develops and leads a comprehensive contracting strategy aligned with growth goals across specialty pharmacy including oral and self-administered injectable therapies, specialty distribution models, and limited distribution drug (LDD) access.

• Serves as a strategic advisor to executive leadership on PBM and specialty network trends, access barriers, reimbursement risk, and evolving regulatory/CMS considerations impacting pharmacy benefit structures.

• Leads complex negotiations with national and regional PBMs and specialty networks to secure and expand network participation, including drug-level pricing, access criteria, performance guarantees, and specialty carve-out structures.

• Oversees contract modeling, financial impact analysis, approval governance, and ongoing performance monitoring to ensure contracts meet margin, growth, and access objectives in a highly competitive and saturated specialty market.

• Partners with finance and analytics to evaluate pharmacy benefit reimbursement methodologies and drug-level economics, ensuring alignment between acquisition cost, reimbursement, and margin performance.

• Acts as the primary liaison between contracting and internal stakeholders including operations, revenue cycle, clinical leadership, legal/compliance, trade, and reporting teams, ensuring specialty contracts are operationalized across the full contract lifecycle.

• Leads, mentors, and develops a team of payor contracting professionals and contract managers, building scalable processes to support high-volume network applications, credentialing requirements, and audit readiness.

• Ensures contracting activities align with federal and state regulations, CMS requirements, and PBM-specific audit and compliance expectations, including performance guarantees, reporting obligations, and specialty pharmacy accreditation standards.

 

Minimum Requirements:

Requires a Bachelor’s degree and minimum of 10 years of progressive experience in payor contracting, reimbursement, or managed care within specialty pharmacy, infusion services, PBM, or health plan environments, including demonstrated success leading complex national and regional negotiations and proven people leadership experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

• MBA/advanced degree with deep experience in specialty pharmacy, including limited distribution drugs (LDDs), specialty carve-outs, value-based/outcomes-based contracts, and strong understanding of Medicare Part D, Medicaid, and commercial payor dynamics preferred.

• Proven experience negotiating with PBMs and securing access into specialty pharmacy networks, including application-based entry, accreditation, and audit readiness requirements preferred.

• Strong knowledge of specialty drug landscape, including disease states, drug pipelines, utilization management, and drug-level contracting strategies tied to reimbursement and access preferred.

• Demonstrated ability to drive revenue through network access strategy in a highly competitive, saturated specialty market, including partnership with trade, operations, RCM, and clinical teams preferred.