Job Description

Summary

The Vice President of Commercial Development will lead the development and execution of strategies that provide vision, leadership, and management in payer contracting. This role focuses on maximizing reimbursements, ensuring compliance, optimizing payer relationships, and enhancing reimbursement processes, all with the goal of driving overall business growth. By strengthening CSI Pharmacy’s standard of excellent patient care, the VP of Commercial Development will effectively oversee relationships with both payers and employer groups, while collaborating with payer consultants to advance the organization's strategic objectives.

Essential Duties and Responsibilities

include the following. Other duties may be assigned, as necessary.

• Develops and implements comprehensive payer strategies to drive revenue growth and market expansion.
• Aligns payer strategies with the organization's overall goals and objectives.
• Leads initiatives to improve payer relationships, including negotiations, contracting, and value-based agreements.
• Oversees relationships with health insurance companies, managed care organizations, and other payers.
• Negotiates contracts, including fee-for-service, capitation, and value-based agreements.
• Monitors payer performance and addresses issues related to reimbursement, denials, and payment delays.
• Leads efforts to engage large employer groups, providing them with tailored healthcare solutions.
• Develops strategies to meet the healthcare needs of employer groups, including wellness programs, disease management, and cost-containment strategies.
• Collaborates with sales and account management teams to drive employer group growth and to support product launches and initiatives.
• Leverages payer consultants' insights to refine strategies, improve negotiation outcomes, and enhance payer relationships.
• Leads and mentors a team of professionals, including those focused on payer strategy, employer group sales, and consultant relations fostering a culture of collaboration and innovation.
• Develops and implements training programs to enhance the skills and knowledge of the team.
• Dedicated to continuous professional growth and staying updated about industry trends and regulations.
• Monitors market trends, regulatory changes, and competitive activities to inform payer and employer group strategies.
• Conducts thorough analyses of payer data to identify areas for improvement and growth.
• Utilizes data-driven insights to influence decision-making, strategy formulation and refines/adjusts strategies as needed to achieve optimal results.
• Works cross-functionally with clinical, finance, legal, compliance, and operational teams to ensure seamless alignment and execution of payer strategies.
• Collaborates with marketing teams to develop messaging and materials that resonate with payers and employer groups.
• Engages with clinical leadership to align payer strategies with clinical goals and patient outcomes.
• Ensures all payer strategies, contracts and employer group engagements comply with relevant federal and state laws and regulations.
• Stays informed about changes in healthcare laws, regulations, and policies that could impact payer strategies.
• Works with the legal and compliance teams to mitigate risks and ensure adherence to industry standards.
• Tracks the performance of payer contracts and employer group initiatives against key metrics and objectives.
• Prepares and presents regular reports to executive leadership on the progress, challenges, and successes of payer strategies.
• Provides subject matter expertise on legislation, regulation, and accreditation standards related to managed care programs and other insurance laws and regulations.
• Conducts competitor analyses to identify opportunities and threats in payer strategies.
• Develops and tracks key performance indicators (KPIs) related to payer contracts and reimbursements.
• Monitors the effectiveness of payer strategies and adjusts them as necessary.
• Provides guidance and training to staff on payer-related issues.
• Oversees budget planning and resource allocation for payer strategy initiatives.
• Evaluates and optimizes expenditures related to payer relationships.
• Presents updates and strategic recommendations to executive leadership and the board of directors.
• Plans, directs, and coordinates contract language, rate pricing, negotiations, revenue reconciliation, and payer relationship management.
• Leads the design, development, and distribution of database tools and applications to efficiently measure, monitor, and/or forecast structure and performance of payer contracts.
• Builds and maintains strong relationships with key payer partners, including but not limited to the Intake Team, clinical leadership, RCM team, and senior leadership.
• Operationally integrates new entities into the existing portfolio.
• Complies with Company’s Core Values and Core Competencies.
• Performs other duties as assigned by the manager.

Qualification Requirements

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.

• Strong analytical, negotiation, and leadership skills.
• Essential knowledge of managed care, billing, and operational issues in a home or specialty infusion environment.
• Professional-level expertise in business and healthcare administration.
• In-depth knowledge of managed care concepts, including value-based contracting.
• Strong understanding of state and federal laws applicable to managed care.
• Comprehensive understanding of finance, information systems, marketing, and clinical operations processes, including the regulatory environment, provider community, and payers in new markets.
• Detail-oriented with a professional attitude, reliability, and the ability to provide concise, accurate responses to C-Suite personnel on managed care matters.
• Strong management and organizational skills to effectively lead this function.
• Ability to follow and provide clear verbal and written instructions, with sufficient grammar and spelling skills to avoid errors or misinterpretations.
• Excellent interpersonal skills to support customer service, functional team needs, and teammate collaboration.
• Effective communication skills in English, both verbally and in writing.
• Mathematical and analytical abilities for problem-solving, ranging from basic to intermediate levels.
• Proficiency in Microsoft Excel, Word, and Outlook.
• Specialized knowledge of systems related to the job function.

Education and/or Experience

• Bachelor’s degree in healthcare administration, business, or a related field; MBA preferred.
• 10+ years in healthcare management, with a focus on payer relations or managed care.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or listen. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

Comments

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

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JR# JR252521