Senior Director, Strategic Payer Relations - Myrtle Point - CarepathRx

Description

Overview

AnewHealth is one of the nation's leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.

Job Details

The Senior Director, Strategic Payer Relations is a senior leader responsible for managing and advancing strategic relationships with assigned payer organizations. This role serves as the primary relationship owner for designated payers and is accountable for payer access, retention, reimbursement performance, and overall relationship health.

Operating within the newly formed Payer Relations and Market Strategy organization, the Senior Director will engage routinely with Director-, Vice President-, and Senior Vice President-level payer leaders and will represent the organization in high-impact discussions related to network participation, reimbursement models, and payer performance optimization.

This role works in close collaboration with internal clinical, contracting, policy, analytic, finance and operational leaders to ensure coordinated execution of payer strategies that support enterprise revenue and margin growth.

Key Responsibilities

Strategic Payer Relationship Management

• Serve as the primary relationship owner for a defined portfolio of strategic payer organizations.

• Lead executive-level engagement with payer stakeholders, including Directors, Vice Presidents, and Senior Vice Presidents.

• Establish and maintain strong, credible relationships that support network access, retention, and reimbursement improvement objectives.

• Ensure consistent, coordinated communication and positioning across all payer interactions.

• Lead master account planning for assigned portfolio and conduct payer quarterly business reviews

Reimbursement & Performance Optimization

• Drive initiatives aimed at improving reimbursement performance and financial outcomes across assigned payer relationships.

• Partner with internal contracting, clinical effectiveness, pharmacy, and finance teams to support payer-specific strategies.

• Monitor payer performance trends, identify gaps or risks, and proactively address issues impacting access, reimbursement, or operational execution.

Cross-Functional Collaboration

• Collaborate closely with peers across Clinical Effectiveness & Stars Experience, Government & Professional Affairs, Strategic Contracting, and Market Strategy.

• Align payer engagement activities with enterprise priorities, regulatory considerations, and contracting strategies.

• Support internal readiness for payer discussions by coordinating data, insights, and materials as needed.

Governance, Execution & Communication

• Support governance processes related to payer engagement, escalation, and decision-making.

• Prepare executive-level summaries, updates, and recommendations for senior leadership as required.

• Ensure disciplined follow-through on commitments made to and by payer organizations.

• Maintain accurate documentation of payer interactions, priorities, and outcomes.

Function Development Support

• Contribute to the development of scalable processes, tools, and best practices for the evolving Strategic Payer Relations function.

• Support onboarding, mentoring, and collaboration with other Senior Directors as the team expands.

• Assist the Vice President, Strategic Payer Relations, in shaping role clarity, engagement models, and operating cadence during the function formation phase.

Qualifications

Required Qualifications

• Bachelor's degree required; advanced degree preferred.

• 10+ years of progressive experience in payer relations, health plan engagement, healthcare strategy, contracting support, or related healthcare leadership roles at payer organizations including PBMs, Health Plans or government payer organizations.

• Demonstrated experience engaging senior-level payer stakeholders (Director, VP, SVP).

• Strong understanding of payer structures, reimbursement models, network access dynamics, and healthcare economics.

• Proven ability to operate effectively in complex, matrixed organizations.

• Strong executive communication skills, both written and verbal.

Preferred Qualifications

• Experience supporting payer strategies across national and/or regional payers.

• Background working closely with contracting, clinical, pharmacy, or reimbursement-focused teams.

• Experience contributing to new function or capability development within a healthcare organization.

• Ability to synthesize complex information into clear executive-level insights.

Key Competencies

• Executive presence and credibility with external stakeholders

• Strategic thinking and disciplined execution

• Strong collaboration and influence without direct authority

• Analytical mindset with a focus on outcomes

• Comfort operating in evolving and ambiguous environments

• High degree of accountability and follow-through

Working Relationships

• Internal: President & Chief Payer Relations and Market Strategy Officer, VP Strategic Payer Relations, Clinical Effectiveness & Stars Experience, Government & Professional Affairs, Strategic Contracting, Finance, Analytics, Growth, Legal, and Operations

• External: Strategic payer organizations, including PBMs, national and regional health plans and other payer entities

AnewHealth offers a comprehensive benefit package for full-time employees that includesmedical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits,401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire .

AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.