Restructuring & Turnaround Consulting Director
Huron
Senior Director, Pharmacy Accelerator – Payor Strategy
Pillr Health
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteJob 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.
