Manager, Payor and PBM Relations

The Manager, Payor & PBM Relations is responsible for leading efforts to secure and maintain access to specialty pharmacy networks on behalf of the hospital system's specialty pharmacy. This role serves as the primary liaison between the health system and Pharmacy Benefit Managers (PBMs), focusing on network inclusion, credentialing, contract negotiation, and performance alignment to ensure access to specialty drugs and high-cost specialty therapies.

Requirements

• Develop and execute payer engagement strategies and operational frameworks that enhance access, streamline payer interactions, and support revenue optimization.
• Collaborate with Clearway teams and health system partners to address payor, PSAOs and PBMs access and reimbursement challenges, tracking data and troubleshooting with internal and external teams.
• Recommend and educate internal and external partners on reimbursement opportunities and potential solutions.
• Build effective working relationships with national and local payors, PBMs, and PSAOs, ensuring preferred access to their networks through influence and negotiation.
• Review reimbursement rates and recommend improvements as necessary, keeping up to date with current best practices.
• Evaluate managed care trends, coverage patterns, and payer policies, providing information and education to Clearway and health system partners as needed.
• Maintain a thorough knowledge of payor policies and industry developments related to specialty pharmaceuticals.
• Provide direct supervision of team member(s) including setting priorities, defining strategy, overseeing credentialing project execution, and ensuring alignment with organizational goals.
• Coach and develop team members through regular feedback, performance management, and mentorship while maintaining ownership of team deliverables, quality standards, and continuous improvement of credentialing processes.

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan
• 20% Travel Allowance