Strategic Engagement Manager overseeing relationships for high - value accounts in healthcare solutions. Developing strategies to drive growth and improve client retention within Zelis.
About the role
- Payor Contract Manager managing contracts for specialty pharmacy, overseeing compliance and reimbursement methodologies, and supporting internal teams. Requires a bachelor’s degree and 5 years of experience in managed care.
Responsibilities
- Manages the lifecycle of payor contracts including review, interpretation, implementation, amendments, and renewals
- Serves as subject matter expert on contract terms including reimbursement methodologies, fee schedules, carve-outs, drug-level pricing, site-of-care requirements, and network participation
- Tracks contract expirations, renewals, and amendments to ensure uninterrupted access and compliance
- Analyzes reimbursement methodologies (AWP, WAC, ASP, MAC, per diem, case rates, nursing fees, supplies, admin fees) and identifies reimbursement risks, underpayments, and revenue leakage
- Partners with finance and revenue cycle to resolve reimbursement discrepancies and payment disputes and supports forecasting, margin analysis, and payor profitability reporting
- Translates contract terms into operational requirements for pharmacy systems, billing platforms, and claim adjudication logic and coordinates with IT and pharmacy operations to ensure accurate setup of pricing and payor-specific rules
- Supports payor mapping tied to BIN/PCN, NCPDP, NPI, and taxonomy configurations
- Ensures contracts comply with federal and state regulations including CMS, Medicare Part B and D, Medicaid, 340B, and anti-kickback requirements; maintains audit-ready documentation; and supports internal/external audits
- Acts as the primary contract resource for internal teams; provides contract education to support accurate billing and payor compliance; and supports payor escalations, access issues, and network participation inquiries
Requirements
- Requires a Bachelor’s degree in Business, Healthcare Administration, Finance, or related field
- Minimum of 5 years of experience in payor contracting, managed care, or contract administration within specialty pharmacy, infusion pharmacy, PBM, or health plan environments
- Any combination of education and experience which would provide an equivalent background
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Behavioral Health Care Manager I managing neurodevelopmental and psychiatric disorders at Elevance Health. Providing flexible virtual full - time care management and ensuring access to quality behavioral healthcare.
LTSS Service Coordinator responsible for assessments and coordinating care for individuals with specialized programs. Engaging with members and their support systems while working primarily in the field.
Nurse Case Manager I responsible for care management of members with chronic health needs. Work remotely with required in - person training sessions and collaboration with medical directors.
LTSS Service Coordinator facilitating service coordination for individuals in specialized programs. Conducting assessments and managing physical and behavioral health needs in Florida communities.
LTSS Service Coordinator responsible for managing service coordination for individuals with health care needs. Conducting assessments and facilitating person - centered planning in specialized programs.
LTSS Service Coordinator handling service coordination for specialized programs. Conducting assessments and developing Person Centered Support Plans while engaging with individuals and their support teams.
LTSS Service Coordinator overseeing service coordination for individuals in specialized programs at Elevance Health. Engaging with clients and support networks, ensuring care management and compliance with requirements.
Payor Contract Manager managing payor contracts for Elevance Health's infusion services. Ensuring compliance and optimization of reimbursement across commercial and government payors in a hybrid work setting.
LTSS Service Coordinator providing support and case management for clients in Florida, overseeing non - clinical needs and collaborating with care teams. Conducting assessments and managing a defined caseload in specialized programs.