Director, Payer Relations

OneOncology

6d•Remote

About The Position

The Director, Payer Relations leads the strategy, negotiation, and management of Pharmacy Benefit Manager (PBM) contracts across OneOncology’s network of practices. The role ensures contracting strategies align with financial objectives, regulatory requirements, and organizational priorities. As a subject matter expert, the Director partners with practice leadership and cross-functional teams to optimize reimbursement, resolve complex payer issues, and support value-based care initiatives. This position operates with a high degree of independence and may build, lead, and develop a team as business needs evolve. The Director reports to the Vice President, Payer Relations.

Requirements

Bachelor’s degree in business, finance, healthcare administration, or a relevant field.
At least 5 years of people-management experience, preferably including remote-team leadership.
At least 8 years of relevant experience with PBM contracting for a hospital, clinic, physician practice, or healthcare system.
Knowledge of legal and regulatory requirements in healthcare as they relate to payer contracting and reimbursement.
Current industry experience negotiating PBM contracts, including contract terms, reimbursement methodologies, and financial considerations.
Ability to travel as needed to support business and practice needs.
Deep understanding of contract language and a successful track record negotiating language changes that support favorable financial and operational outcomes for practices.
Experience developing and executing contracting strategies, evaluating financial impacts, and influencing decisions across multiple stakeholders.
Ability to work with minimal supervision while maintaining alignment with team and organizational objectives.
Excellent written and verbal communication skills; strong negotiation, influencing, conflict-resolution, and relationship-building skills.
In-depth knowledge of Medicare, Medicaid, commercial insurance, the PBM space, drug reimbursement methodologies, and analytics models.
Proficiency with financial reports and modeling to evaluate contracting opportunities and financial impacts.
Experience in value-based care program development.
Strong attention to detail, innovative problem-solving, critical thinking, and ability to develop strategic recommendations.
Ability to manage multiple complex projects and competing priorities simultaneously.
Ability to coach, mentor, and develop team members while promoting accountability and continuous improvement.
Strong business acumen and ability to align PBM contracting strategies with organizational priorities and financial objectives.
Attendance is an essential job function.

Nice To Haves

Master’s degree.
People-management experience leading remote teams.
Current or previous PBM payer-contracting experience.

Responsibilities

Ensure contractual arrangements for assigned PBM contracts are accurate and meet financial targets and legal and regulatory requirements.
Negotiate contract language according to department standards to achieve favorable financial and operational outcomes.
Monitor PBM industry trends, reimbursement changes, and regulatory developments to identify risks and strategic contracting opportunities.
Support other departments in resolving chronic PBM-specific payer issues related to assigned contracts.
Present on PBM-related topics at practice-facing meetings as needed and when approved by the VP.
Provide expertise in PBM contracting and reimbursement for internal decision-making and practice education; identify educational needs and escalate issues to appropriate practice or OneOncology leaders.
Work in a matrix environment with multiple and competing customer demands, focusing on client satisfaction through internal and external communication.
Partner with the VP to develop annual team goals and budget targets and monitor progress toward objectives.
Create action plans to address team-member performance gaps; coach, provide feedback to, and develop assigned team members.
Collaborate with the VP to assess department tools and talent needs.
Partner with the VP to create and execute payer strategy for markets annually or as needed.
Manage staff and department activities, drive negotiations, and assist the VP in monitoring department needs and achieving objectives.
Create content and lead team meetings as necessary.
Operate as a strategic leader with minimal oversight, driving initiatives and identifying improvement opportunities aligned with the VP’s vision.
Collaborate with the VP on value-based care programs, alternative payment models, or external partnerships that drive revenue for practices.
Perform additional responsibilities as assigned to support the organization’s mission.