Description

WHO WE ARE
Polaris Pharmacy Services is an industry leader in both the Long-Term Care and Post-Acute Care settings. Founded in 2015, we are locally and independently owned with pharmacies nationwide. We are proud to offer competitive benefits and industry pay as well as the opportunity for career advancement to all our team members.

Job Summary:

The VP of Payer Relations is responsible for leading and managing all aspects of payer relations, including contract negotiations, relationship management, and strategic partnerships with health plans, pharmacy benefit managers (PBMs), and other payers. This role is crucial for ensuring favorable reimbursement rates, maximizing patient access to medications, and driving revenue growth for Polaris Pharmacy Services.

Duties/Responsibilities:

• Develop and implement payer relations strategies that align with Polaris Pharmacy Services' overall business objectives.
• Lead contract negotiations with payers, securing optimal reimbursement rates and terms for pharmacy services.
• Build and maintain strong relationships with key decision-makers at health plans, PBMs, and other payer organizations.
• Monitor and analyze payer trends, reimbursement policies, and industry best practices to identify opportunities and mitigate risks.
• Collaborate with internal stakeholders, including pharmacy operations, finance, and legal, to ensure effective implementation of payer contracts and programs.
• Oversee the development and submission of proposals, presentations, and other materials to payers.
• Resolve payer-related issues and disputes in a timely and efficient manner.
• Manage a team of payer relations professionals, providing guidance, mentorship, and performance feedback.
• Track and report on key performance indicators related to payer contracts, reimbursement rates, and patient access.
• Stay abreast of industry regulations and ensure compliance with all applicable laws and guidelines

Qualifications

QUALIFICATIONS/COMPETENCIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required Skills/Abilities:

• Excellent communication, negotiation, and interpersonal skills.
• Strong analytical and problem-solving skills.
• Ability to think strategically and develop innovative solutions.
• Proficiency in Microsoft Office Suite, including Excel, PowerPoint, and Word.
• Knowledge of pharmacy benefit management (PBM) operations and industry best practices.
• Ability to work independently and as part of a team.
• Strong organizational and time management skills.
• Ability to travel as needed.

EDUCATION and/or EXPERIENCE:

• Bachelor's degree in Business Administration, Healthcare Administration, or a related field. A Master's degree (MBA, MHA) is preferred.
• Minimum of 10 years of progressive experience in payer relations, contracting, and network management within the healthcare industry, preferably in pharmacy benefit management (PBM), specialty pharmacy, or a related field.
• Proven track record of successful negotiations with national and regional payers, including commercial health plans, Medicare Part D plans, and Medicaid managed care organizations.
• Extensive experience in developing and implementing payer strategies, contract terms, and reimbursement models.
• Demonstrated ability to build and maintain strong relationships with key payer stakeholders, including executives, medical directors, and pharmacy directors.
• Experience managing a team of payer relations professionals and providing leadership and mentorship.
• Strong understanding of healthcare regulations, policies, and industry trends related to payer contracting and reimbursement.
• Experience with financial modeling, data analysis, and contract performance reporting.

PHYSICAL DEMANDS

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job:

• May sit or stand seven (7) to ten (10) hours per day
• The employee is occasionally required to sit; climb or balance; and stoop, kneel, bend, walk
• May be necessary to work extended hours as needed
• May lift and/or move up to 30 pounds
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this role

HOLIDAY & PTO POLICY

• Paid holidays are provided annually, with 6 days offered each year, along with 5 sick days.
• Employees earn up to 10 PTO days each year, with rollover options and milestone bonuses.
• Employees have the option to cash out up to 10 PTO hours each quarter for added financial flexibility.

Please note, because we are a pharmacy most of our locations are open 24-hours a day, 7 days a week and therefore schedules may change as determined by the needs of the business.

BENEFITS for full time Employees

• Medical, Dental, and Vision insurance
• 401 (k) (available for Part Time & Full Time EEs)
• Company Paid Life insurance
• Short-term and Long-term disability insurance
• Tuition reimbursement
• Personal Time Off (PTO)
• Competitive pay with annual performance reviews and merit-based raises
• Career growth potential
• Annual on-site voluntary Flu Vaccines
• Employee referral bonus program