Vice President, Managed Care

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

The VP, Managed Care provides guidance to stakeholders on payor contract information. This role is for a working manager who will excel in a mix of executive-facing and transformational project-focused responsibilities. The VP will be responsible for building and maintaining a knowledge base of home infusion contract reimbursement information and using that subject matter expertise to advise CarePathRx’s growing number of health system partners.

Responsibilities:

• Partner with CarePathRx’s health system partners on optimizing contracts for their home infusion pharmacy.

• Develop payor priorities for securing contracts.

• Review payor contracts and related amendments, providing recommendations.

• Provide guidance during health system partner implementation of their home infusion pharmacy.

• Align all processes to the overall implementation timelines, including payor credentialing application process.

• Provide consultation, education, and training on contract requirements to Intake and Billing/Collection teams, including information regarding payor reimbursement methodologies, rates, and policies.

• Work cross-functionally to ensure contract or amended rates and payor information is loaded accurately by the appropriate team for authorization, billing, and claims functions.

• Maintain the knowledge base particular to benchmark rates and managed care terms; leverage this data to inform health system partner strategies.

• Manage payor contract and amendment reimbursement-related reference materials to support other teams (e.g., Intake, Billing/Collections).

• Work with billing & collections teams to review payor payment trends and investigate payment variances for payor contract non-compliance; leverage payor relationships/contacts to assist in collecting outstanding AR and reversing denials.

• Develop and implement CarePathRx MSO managed care strategy.

• Manage Chartwell managed care team and grow new contracts nationwide.

• Oversee Chartwell licensing process.

• Lead contracting efforts for CarePathRx SP customers.

• Collaborate with MSO revenue cycle teams.

• Contract for AIC/AIS customers.

• Play a lead role in manufacturer programs requiring managed care strategy.

• Other duties as assigned

Skills & Abilities:

• 10+ years of payer or contract management experience in specialty pharmacy, infusion therapy, or related field.

• 4-5 years of experience with Home Infusion therapies and their associated drugs & HCPC.

• Advanced knowledge of health insurance plans: Managed Care Organizations, PPO, POS, Self-Funded, TPAs, and providers at financial risk (hospital/health systems, medical group/IPA).

• Knowledge of HIPAA guidelines, federal, state, and local regulations related to pharmacy or healthcare providers.

• Expertise in building strong relationships with regional and national payors and health system clients in the managed care and leadership arena.

• Ability to assist in training and education of staff.

• Ability to manage multiple priorities.

• Ability to work independently.

• Proficiency in Microsoft Excel, Microsoft Word, and PowerPoint.

• Experience with CPR+ system preferred.

CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.