Manager, Payer Strategies - Specialty Pharmacy

Optime Care | Earth City, MO | Hybrid position 

Shape the Future of Healthcare

Join our innovative team at Optime Care as a Manager, Payer Strategies, where you'll make a meaningful difference in the lives of patients facing complex, chronic conditions and rare diseases. In this exciting role, you'll have the opportunity to manage key aspects of Optime Care’s strategies, activities, and relationships between potential clients, current clients, internal team members, and the payer community, as well as being a resource for physician offices. This position will manage our Insurance Coordinators, who support the Care Teams and our patients with specific insurance questions and information.

This role will be hybrid, based at our Optime Care Office in Earth City, MO, and will be required to be in the office a minimum of 3 days a week.

Join Optime Care - Where Innovation Meets Patient Care

About the role

Critical parts of the job/Key Responsibilities

• Collaborate with Senior Leadership to support planning, development, and implementation of strategies to support communication with potential and current clients related to payers
• Support planning and development of strategies to support payer activities internally
• Collaborate with Licensing and Payer Specialist to negotiate and validate reimbursement rates for each drug on behalf of Optime Care and the client at the lowest possible discount
• Support Care Teams in gaining insurance coverage for prescribed therapies
• Complete and submit applications for contracting for health plans, PBMs, and wholesale licenses
• Communicate terms of contracts to the team, ensure timely delivery of PBM/Health Plan required reports
• Support functions of Finance and Quality teams
• Support Care Coordinators and/or Finance in achieving correct reimbursement rates from payers
• Train new personnel on PBM and Health Plan contracting as it relates to their role
• Serve as a resource for all team members
• Perform other related duties as assigned or necessary; remain flexible and adaptable in work schedules and assignments as defined by departmental and organizational needs.

What will the position focus on

Collaboration – You will collaborate with various departments and groups within the organization regarding the strategies and implementation of communication plans with potential and current clients.

Subject Matter Expertise – You will be the Subject Matter Expert (SME) and help support the different parts of the organization and our patients on all things Payer. This includes contract support, negotiations, training, and supporting the development and planning of internal payer activities.

Skills, Education & Abilities

Essential Requirements

• Knowledge of Medicare and Medicaid billing
• Experience with prior authorization and SMN preparation
• Knowledge of claim appeals
• Medical terminology required
• Knowledge of medical/pharmacy insurance benefit language; ie. EOB’s, deductibles, Out of pocket, co-insurance, co-pays, etc.
• Exceptional communication and leadership skills; able to balance empathy with accountability while navigating many different personalities.
• Strong oral and written communication skills.
• Excellent leadership skills and the ability to navigate different personalities.
• Strong attention to detail, process-oriented, excellent organizational skills, and adherence to deadlines.
• Ability to work and adapt in a complex, dynamic organization.
• Must be able to effectively multitask and work in a fast-paced environment with the ability to prioritize competing tasks.
• Ability to manage time-sensitive documents.
• Ability to work independently, as well as in a team environment.
• Interact effectively and productively with colleagues and business partners.
• Proactive and communicative, knows when to escalate.
• An innovative thinker willing to bring forth ideas to enhance processes.
• Proficiency in Microsoft Office Suite, specifically Excel, Word, PowerPoint, and Outlook.
• Excellent presentation skills.

Qualifications

• Five (5) or more years of progressive experience in specialty pharmacy and the orphan drugs market.
• Previous experience in insurance and payer markets related to prescription plans, claims, and rebates.

Preferred Qualifications

• Patient Assistance Program knowledge a plus

 

Ready to make an impact? Join us on our mission to transform specialty pharmaceutical services and improve patient lives. We’re looking for passionate professionals who share our commitment to excellence and innovation. Apply today and become part of a team that’s shaping the future of healthcare.

About Us

Optime Care is a Specialty Pharmacy dedicated to providing services to smaller patient communities. We focus on securing insurance coverage, coordinating care, and complying with therapy regimens are only a few examples. Our mission is to minimize the daily impact of living with unique disorders. After just one call, our experts begin to address everything from medication delivery and insurance reimbursement to compliance and education. Every patient receives a proactive service experience tailored to their specific needs.

Optime Care provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.