Director Pricing - CarelonRx

Elevance Health • Tampa, FL

3d • Hybrid

About The Position

Director Pricing - CarelonRx Location: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Director Pricing leads pricing strategy, financial modeling, and payor negotiation support for infusion and specialty pharmacy services and ensures that standardized and approved processes are utilized for pricing governance, contract financial review/approval, and post-implementation performance monitoring to drive competitive, compliant, and profitable reimbursement across commercial, Medicare, Medicaid, and employer-sponsored plans, supporting both pharmacy and medical benefit structures.

Requirements

• Requires a Bachelor’s degree in Finance, Economics, Business, Healthcare Administration, or related field and 8–12+ years of experience in healthcare pricing, payor contracting, or financial strategy, including direct experience with infusion and/or specialty pharmacy reimbursement and contracting; deep understanding of reimbursement methodologies (AWP, ASP, WAC, per diem, case rates, bundled pricing); advanced financial modeling and Excel skills; and experience supporting negotiations with commercial health plans, PBMs, and government payors; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• MBA/advanced degree with experience in home infusion, specialty pharmacy, AICs, health system-based pharmacy services, and strong understanding of Medicare Part B, Part D, Medicaid, and value-based/alternative payment models preferred.
• Experience building and maintaining end-to-end financial models that incorporate drug acquisition cost, reimbursement methodologies, utilization, and site-of-care dynamics across both infusion and specialty pharmacy preferred.
• Strong understanding of trade (drug purchasing), reimbursement, and profitability, including ability to evaluate margin at the contract, drug, and therapy level across pharmacy and medical benefits preferred.
• Experience supporting pricing strategy across both PBM/pharmacy benefit and health plan/medical benefit environments, with ability to translate complex financial insights into negotiation and business strategy preferred.
• Proven ability to work cross-functionally with contracting, finance, trade, operations, and clinical teams, including experience in consultative or analytics-driven roles building scalable pricing tools and governance processes preferred.
• Demonstrated ability to support executive decision-making in fast-paced environments through advanced financial modeling, ad hoc analysis, and clear communication of complex pricing and reimbursement dynamics preferred.

Responsibilities

• Develops and maintains pricing models across drug, professional, supply, and ancillary components; evaluates the financial impact of proposed payor terms (rates, fees, discounts, carve-ins/outs, performance guarantees); and leads scenario modeling for new opportunities, network expansions, and renegotiations across both infusion and specialty pharmacy.
• Serves as the pricing lead for payor negotiations with national, regional, and local health plans, PBMs, and employer groups; and translates complex reimbursement methodologies (AWP, ASP, WAC, per diem, case rates, bundled payments, value-based arrangements) into executive-level insights to inform contracting strategy.
• Supports network participation strategy including access, tiering, and site-of-care considerations; and reviews and approves financial terms for LOIs, amendments, and MSAs, ensuring alignment between reimbursement and drug acquisition cost.
• Analyzes contract performance after implementation to confirm expected reimbursement and margin outcomes at both the contract and drug level, identifies underperforming contracts or therapies, and recommends remediation strategies.
• Partners with Revenue Cycle, Billing, Trade, Finance, and Operations to ensure pricing terms are operationalized accurately and consistently and reflect real-world purchasing and reimbursement dynamics; and supports audit responses related to pricing, reimbursement, and contract interpretation.
• Establishes pricing governance, approval processes, and documentation standards; acts as a strategic advisor to Contracting, Sales, and Executive leadership; and manages/mentors pricing analysts or managers as applicable, including future team build-out.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Director