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Manager, Pharmacy Payor Services
CPS Solutions, LLC
Home-Based / Remote
- Facilitate and assist in the development of client-specific specialty and Ambulatory pharmacy payor implementation plans. This includes identifying requirements, project management, assisting in financial assessments, review of benefits and services , pharmacy and ERx data review, revenue cycle management review and value, and managing requests and purchases.
- Assist in the development and successful execution of integrated plans for the delivery of payor enrollment and other key initiatives to achieve high quality affordable care and improve the health of those served.
- Being an essential and critical business partner with client and CPS Solutions leadership teams. This includes facilitating payor enrollment, Claims Reconciliation and payor credentialing & reporting.
- Collaborate on the ongoing assessment of existing payor pharmacy practices and initiatives; prioritize and lead appropriate and required changes.
- Support a collaboration between clients' pharmacy, medical contracting and key stakeholder to leverage organizational, pharmaceutical and medical expertise to develop and maximize payor programs, strategy and access.
- Execute upon goals, strategies, and tactics to ensure ongoing client success. This includes helping clients grow their pharmacy programs and ensuring that their program achieves profitable growth.
- Be integral in the development of specialty pharmacy operations related to payor relations and lead the progression of the pharmacy culture, the commitment to outcomes quality and efficacy, patient centered healthcare.
- Promote and assure a high level of collaboration and coordination in the development and consistently successful payor strategy execution.
- Identify opportunities and issues that impact client services and performance by engaging key stakeholders to plan, develop, and successfully execute timely and appropriate initiatives and solutions that result in appropriate performance improvement.
- Establish systems to manage external relationships with third-party payors on behalf of CPS clients, including overseeing compliance and credentialing of programs and specialty pharmacy network contract.
- Under the direction of senior leaders and in collaboration with strategic business partners, clients, and key stakeholders, develop the optimal utilization of technology, including but not restricted to, proprietary clinical specialty pharmacy IT platform.
- Provide leadership and direction in the development and successful execution of integrated strategies for the implementation and utilization of proprietary pharmacy IT payor platform to achieve high quality documentation of payor successes.
- Perform other related duties as assigned.
- Bachelor's Degree in a health care related field or in lieu of degree, comparable industry experience.
- 2 years of successful internal and external leadership through relationship management.
- 5 years of related Payor Relations experience in Specialty Pharmacy to include: Experience managing and/or collaborating with pharmacy payors, including but not limited to contracting and enrollment processes;, Demonstrated experience working with diverse stakeholders enhancing business results through high quality and cost effective specialty pharmacy services; executing complex projects (preferably in a hospital setting);, building effective relationships with key stakeholders;, and experience with optimization strategies is preferred.
- Proficient with Microsoft tools: Outlook, Teams, Word, Excel and PowerPoint
- Able to travel up to 60% of the time by plane or car.
- Able to meet company standards for a MVR.
Benefits: All employees enjoy a competitive salary, eligibility to participate in the 401(k) savings plan with a match. Full Time employees are also eligible for a comprehensive benefits package, including Medical, Dental and Vision Insurance, Time Off Plan, Company Paid Short- and Long-Term Disability, Basic and Supplemental Life Insurance, Medical Flex and Dependent Care Accounts and more.
CPS Solutions, LLC Requirements: All employment offers are contingent upon successfully passing a pre-employment (post offer) background check, drug test and signed onboarding documents. Additionally, you may be required to provide medical records or have additional medical examinations/background checks that are a specific requirement of the location or position in which you are hired. Due to the healthcare requirements of the location where you will work and the clients we support, this may include a COVID vaccine. This applies to internal transfers and status changes for internal CPS Solutions, LLC team members. CPS Solutions, LLC is also committed to a safe and drug free workplace. The use of marijuana for medical purposes accompanied by a prescription, even if permitted by state law, will not be considered acceptable for purposes of explaining a positive lab test result for marijuana.
About CPS Solutions, LLC: Founded nearly 50 years ago and employing over 2,500 clinical, regulatory, and operational pharmacy professionals, CPS Solutions, LLC, is one of the nation's largest providers of pharmacy services to more than 800 hospitals and healthcare facilities nationwide. CPS Solutions, LLC helps clients tackle a variety of complex issues, such as operational efficiency, rising drug costs, regulatory & compliance, 340B, and specialty pharmacy strategy. CPS Solutions, LLC helps healthcare leaders drive best in class pharmacy operations through skill, expertise, and proprietary technologies. For more information, visit https://www.CPS.com.
We are an Equal Opportunity Employer and do not discriminate against any qualified employee or applicant for employment because of race, color, sex, age, national origin, ancestry, religious creed, sexual orientation, gender identity and/or expression, status as a veteran, mental or physical disability or any other federal, state or local protected class.
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