Payer Contracting Executive

Navitus Health Solutions

. Lead payer negotiations end to end, including rate and term negotiation, network participation, performance guarantee structures, and renewal strategy .

Posted 10/13/2026full-timeRemote • United StatesMid-LevelSenior💰 $116,019 - $145,024 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in payer negotiations, including rate and term negotiation, network participation, and compliance with regulatory requirements. Proven ability to develop payer access strategies and manage relationships with payers to ensure contract compliance and operational efficiency.

Highest-signal resume keywords

Payer ContractingNegotiation SkillsPayer Access StrategyRegulatory ComplianceData Analytics

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Payer NegotiationContract ManagementCredentialingData AnalysisPerformance Guarantee StructuresNetwork ParticipationPayer Agreement ReviewOperational Process ReviewSpecialty Pharmacy ReportingBusiness Review Compilation

Soft Skills

Cooperative InteractionRespectful Communication

Certifications & Qualifications

Bachelor's DegreeMaster of Business Administration (MBA)Certified Pharmacy Technician

Industry Keywords

Managed CareSpecialty PharmacyMedicare Part DMedicaidPayer Environment

About the role

Key responsibilities & impact

Lead payer negotiations end to end, including rate and term negotiation, network participation, performance guarantee structures, and renewal strategy
Develop and execute a payer access roadmap for expanded payer contracts
Investigate current networks where Lumicera and its partner pharmacies are not in network
Independently outreach to payers to identify credentialing and network requirements and pursue new access opportunities
Establish, monitor, and negotiate pricing and service agreements with payers
Complete credentialing and new contract applications for payer and government clients
Compile supporting documents and reports for payer applications, contracts, and business reviews
Track agreements through the contracting process with internal and external stakeholder input
Meet with payer representatives to determine account management needs and ensure contract compliance
Reenroll and recredential existing payer and government plans, monitoring proactively for coverage gaps
Coordinate projects involving contracts and data needs for master service agreements, shared service agreements, and scope of work documents
Develop relations and contacts with established payers and resolve discrepancies with claims and payments
Review operational and documentation processes for regulatory and payer-contract compliance
Ensure specialty pharmacy reporting requirements are met to maintain network contracts
Analyze, compile, and prepare data analytics and presentations for payer clients and leadership
Provide periodic and detailed reporting of activities and opportunities to leadership
Ensure compliance with applicable state and federal regulations
Perform other duties as assigned

Requirements

What you’ll need

Bachelor's degree required
Master of Business Administration (MBA) or other graduate degree preferred
Certified Pharmacy Technician or relevant industry certification preferred
5 years of payer contracting, managed care, or specialty pharmacy experience required
Experience negotiating payer or network agreements, preferably in specialty pharmacy or managed care contracting, required
Working knowledge of commercial, Medicare Part D, and Medicaid payer environments and network access requirements required
Participate in, adhere to, and support compliance program objectives
Ability to consistently interact cooperatively and respectfully with other employees

Benefits

Comp & perks

Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Educational Assistance Plan and Professional Membership assistance
Referral Bonus Program – up to $750!