Under the general direction of the VP Client Success, the Payor Contracting Manager provides guidance to stakeholders on payer contract information. This role is for an individual that will excel in a mix of executive-facing and transformational project-focused responsibilities. This Payer Contracting Manager will be responsible for building and maintaining a knowledge base of home infusion contract reimbursement information and using that subject matter expertise to advise CarePathRx’s growing number of health system partners. This role will provide industry knowledge and support to drive the best outcomes for the system.
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.
Responsibilities
Enterprise Strategy & Governance
Partner with CarePathRx’s health system partners on optimizing contracts for their home infusion pharmacy including:
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
Partner guidance during health system implementation of their home infusion pharmacy for the health system partner and CarePathRx including:
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
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Working cross-functionally to ensure contract or amended rates and payor information is loaded accurately by the appropriate team for system optimization
Ensure ongoing success of the home infusion pharmacy contract strategy through:
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
Payer Strategy & Oversight
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
Client & Stakeholder Partnership
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.
Skills & Capabilities
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
Experience with CPR +, CareTend, HCN EMR systems preferred
Qualifications
High School Diploma or GED required, Bachelor’s degree in finance, Accounting, Business Administration, or related field highly desired
Demonstrated 8+ 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
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.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 103,900 - 173,100 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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