Payer Contracting Manager- Evernorth- Hybrid

The Cigna Group

1d•Hybrid

About The Position

The job profile for this position is Contract Senior Advisor, which is a Band 4 Senior Contributor Career Track Role. This role will serve as a liaison and strategic partner to client leadership and internal stakeholders, ensuring alignment between strategy, payer requirements, operational execution, and financial outcomes. As part of Evernorth Health Services, CarepathRx teams are ambitious, compassionate experts advancing pharmacy and care delivery alongside hospitals and health systems nationwide. We invest in people who are curious, resilient, and motivated to grow—while keeping patients at the heart of everything we do.

Requirements

Knowledge of HIPAA guidelines, federal, state, and local regulations related to pharmacy or healthcare providers
Operational knowledge to translate contractual language into successful implementation with teams
Expertise in building strong relationships with regional and national payors and health system clients in the managed care and leadership arena
Ability to manage multiple priorities
Ability to work independently and execute deadlines effectively
Proficiency in Microsoft Excel, Microsoft Word, and PowerPoint
High School Diploma or GED required
Demonstrated 10+ years of payer or contract management experience in specialty pharmacy and/or infusion therapy required
Advanced knowledge of health insurance plans: Managed Care Organizations, PPO, POS, Self-Funded, TPAs and providers at financial risk (hospital/health systems, medical group/IPA).
Strong understanding of healthcare billing, reimbursement, regulatory requirements, and financial controls
Strategic, analytical mindset with the ability to balance long‑term vision and operational outcomes

Nice To Haves

Bachelor’s degree in finance, Accounting, Business Administration, or related field highly desired
Experience with CPR +, CareTend, HCN EMR systems preferred

Responsibilities

Developing payor priorities for securing contracts
Reviewing payor contracts and related amendments and providing related recommendations
Evaluating and analyzing proposed rates against benchmarks, including per diem and drug rates
Aligning all processes to the overall implementation timelines, including payor credentialing application process
Providing consultation, education and training on contract requirements to Intake and Billing/Collection teams, including information regarding payor reimbursement methodologies, rates and policies
Working cross-functionally to ensure contract or amended rates and payor information is loaded accurately by the appropriate team for system optimization
Maintaining the knowledgebase particular to benchmark rates and managed care terms; leverage this data to inform health system partner strategies
Managing payor contracts and amending reference materials to support all teams
Liaison with internal and external teams when needed for resolution of payer processing issues around payer contract load issues
Set the strategic direction for payer contract management, ensuring contracts are operationalized effectively to support accurate benefit verification, billing, and collections.
Oversee payer change management strategy, including prioritization, risk mitigation, and cross‑functional coordination for payer updates across the client base.
Provide executive oversight for payer audits, ensuring timely, compliant, and effective responses while identifying systemic improvement opportunities.
Define cadences for review of contracting pricing and support on best practices to move forward optimizing outcomes and results
Serve as a trusted advisor to client executives and internal leadership, translating payer performance into strategic insights and recommendations.
Foster strong cross‑functional relationships to align operations and partner managed care teams for payer engagement strategies.