Pillr Health

Senior Director, Pharmacy Accelerator – Payor Strategy

Pillr Health

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Job Level

Senior

About the role

  • Negotiate and manage contractual agreements with national and regional payors and PBMs to gain and retain in-network access, understand 340B pricing and requirements.
  • PBM reporting.
  • Partner and work with multiple PSAO’s in the market
  • Evaluate network participation criteria and lead submissions to meet access requirements, including credentialing, accreditation, and performance standards.
  • Collaborate with legal, compliance, and finance teams to ensure contract terms are favorable and align with regulatory and operational standards.
  • Maintain a comprehensive understanding of formulary structures, access restrictions, and rebate strategies that impact specialty pharmacy access.
  • Serve as the primary liaison with payors and PBMs regarding contract performance, dispute resolution, and renewals.
  • Analyze reimbursement rates, performance guarantees, and payor policies to optimize contract value and operational efficiency.
  • Support business development by identifying new network opportunities and assisting with the launch of limited-distribution drug programs.
  • Prepare reports and dashboards to communicate contract status, payor mix trends, and access barriers to internal stakeholders.

Requirements

  • 5+ years of experience working in the health insurance or PBM industries is required.
  • Experience in this role with a pharmacy service organization is a plus
  • Experience in Specialty Pharmacy and 340B.
  • Proven negotiation skills and experience managing complex contracts across multiple stakeholders.
  • Strong analytical and communication skills with the ability to translate complex contractual data into actionable insights.
  • Advanced degree required (PharmD, JD, MPH, MHA, or related); dual degrees strongly preferred.
  • Knowledge of accreditation standards (URAC, ACHC) is a plus
  • Possess strong verbal and written communication skills, suitable for interaction across all organizational levels and external contacts.
  • Demonstrate advanced knowledge and experience in strategic sourcing processes and methodologies.
  • Display expertise in contract structures, terms, conditions, and risk mitigation, with a proven track record in executing and drafting business requirements and key performance indicators.
  • Proficiently use Microsoft Word, Excel, PowerPoint, and Outlook.
  • Exhibit the ability to organize and prioritize work effectively to achieve specific deliverables in a fast-paced environment with tight deadlines and competing priorities.
  • Ability to influence, build and maintain effective relationships with critical external partners and payors which ultimately impacts the business.