Lead Director, Payer Relations

This is a fully remote position, open to applicants in Rhode Island.

📋 Description

• Oversee contract negotiations and manage a designated portfolio of payer relationships, ensuring advantageous rates, terms, and business results.

• Formulate and implement negotiation strategies that align with financial, operational, and market-share goals.

• Assess portfolio performance, recognize risks and opportunities, and propose actions to enhance profitability and growth.

• Establish and nurture executive-level connections with payer organizations.

• Work collaboratively with internal teams across Finance, Legal, Operations, Analytics, and Government Affairs.

• Mentor and develop team members.

• Contribute to best practices in negotiation, talent development, and building organizational capabilities.

⛳️ Requirements

• A minimum of 10 years of experience in payer relations, pharmacy benefit management, retail pharmacy, healthcare contracting, or a related field within healthcare.

• At least 5 years of experience in negotiating contracts and overseeing related financial terms and performance outcomes.

• Proven experience managing a portfolio, book of business, or commercial relationships with accountability for revenue, profitability, or market share results.

• Proficient in presenting, negotiating, and influencing executive-level stakeholders.

• Strong analytical and strategic problem-solving abilities, capable of evaluating complex business and financial scenarios.

• Preferred experience negotiating directly with national PBMs, health plans, or large healthcare payers.

• Familiarity with Medicare Part D, Medicaid, and commercial pharmacy network reimbursement models is preferred.

• Experience in leading, coaching, or developing contract negotiators or payer relations professionals is preferred.

• Background in creating negotiation frameworks, governance processes, or best practices in contracting is preferred.

• Bachelor's degree is required, or an equivalent combination of education and relevant work experience.

• A Master's degree is preferred.

• An advanced degree such as an MBA, PharmD, JD, or related graduate-level education is preferred.

• Up to 25% travel may be required.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.