Soma Capital Portfolio Jobs

Vice President, Pharmacy Services (Payor Relations)

Alto Pharmacy

Alto Pharmacy

Remote
Posted on Saturday, July 6, 2024

Alto Pharmacy is a full-service, digitally-powered pharmacy that makes it simple to live your healthiest life by providing an easier, more supportive and more affordable pharmacy experience. We’re redefining what a pharmacy can do, with fast and reliable prescription delivery, tools like treatment reminders and medication bundling, direct access to care specialists, and support with insurance and cost savings. By focusing on the person behind the prescription, our model boosts adherence, improves health outcomes, and keeps our customers returning month after month. Learn more at www.alto.com.

As the Vice President, Pharmacy Services, you will manage payor relations from strategy and contracting to reimbursement optimization. You will also manage Wholesaler strategy including contracting and pricing negotiations. Your expertise will be required to guide critical strategic decision making.This critical leadership position requires a seasoned professional with a proven track record in payor negotiations, contract development, and a comprehensive understanding of the evolving pharmacy landscape.

Accelerate Your Career as You

Payer Strategy Integration:

  • Provide expertise and key decision support on contracting strategy.
  • Collaborate closely with executive leadership to integrate payor strategy into contracting initiatives, ensuring alignment with organizational goals.
  • Evaluate and enhance payor strategies to drive favorable contract terms and reimbursement rates.

Contract Negotiations and Management:

  • Lead negotiations with payors to secure mutually beneficial contracts and optimal reimbursement structures.
  • Continuously assess and optimize existing contracts, ensuring financial sustainability and competitiveness.
  • Oversee all challenge processes and Payor Accounts Receivable to optimize collections.

Financial Analysis and Modeling:

  • Conduct rigorous financial analyses to evaluate the impact of payor contracts on revenue streams and overall financial performance.
  • Develop and utilize financial models to support negotiation strategies and decision-making.

Audit Support:

  • Support internal and external (payor) audits and translate findings into actionable business recommendations
  • Partner with Supply Chain to implement recommendations stemming from audit findings

Market Intelligence and Risk Assessment:

  • Stay informed about industry trends, competitor activities, and regulatory changes, applying this knowledge to identify opportunities for Alto and mitigate risks.
  • Proactively assess the impact of market dynamics on reimbursement strategies and adjust tactics accordingly.

Strategy Development and Leadership:

  • Partner with the leadership team to formulate strategy and expansion initiatives, drive execution through project management and cross functional collaboration using your knowledge of the pharmacy industry and value chain

Collaboration and Communication:

  • Collaborate seamlessly with cross-functional teams, including finance, legal, operations, and clinical departments, to align payor and wholesaler strategy with overarching business objectives.
  • Effectively communicate contract terms, reimbursement models, and payor strategy implications to internal stakeholders.

A Bit About You

Minimum Qualifications:

  • Bachelor's degree in business, healthcare administration, or a related field. Master's degree preferred.
  • Minimum of 10 years of progressive experience in healthcare contract negotiation, reimbursement, and payor strategy.
  • Demonstrated success in leading and executing payor negotiations and managing complex contracts.
  • Exceptional financial acumen with the ability to analyze and interpret complex financial data.
  • Strong leadership and communication skills with a proven ability to influence and collaborate across all organizational levels.
  • In-depth knowledge of healthcare regulations, compliance, and market dynamics.

Preferred Qualifications:

  • Creative problem solver who is effective at driving change with limited resources, able to see big picture strategy but also understand details and execute
  • Experience managing and coaching teams, establishing performance KPIs
  • Strong communication and willingness/ability to explain complex topics to non-experts
  • Advanced degree in healthcare administration, business, or a related field.
  • Experience in a leadership role within a large healthcare system, specialty pharmacy or payor organization.
  • Proven success in developing and implementing innovative payor strategies that resulted in improved financial performance.
  • Understanding of Wholesaler relationship and experience negotiating contracts and managing relationships
  • Strong network and relationships within the healthcare payor community.

Additional Physical Job Requirements

  • Read English, comprehend, and follow simple oral and written instructions. The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading. Assessing the accuracy, neatness and thoroughness of the work assigned.
  • Communicating with others to exchange information. Expressing or exchanging ideas by means of the spoken word; those activities where detailed or important spoken instructions must be conveyed to other workers accurately, loudly, or quickly.
  • Perceiving the nature of sounds at normal speaking levels with or without correction, and having the ability to receive detailed information through oral communication, and making fine discriminations in sound.
  • Frequent repeating motions required to operate a computer that may include the wrists, hands and/or fingers.
  • Sedentary work: Sitting most of the time, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Walking & standing are required occasionally.

Salary & Benefits

Salary Range: $252,000 - $315,000

Commission Eligible: No

Equity Eligible : Yes

Travel: Yes. Up to 30% of the time

Location Requirement: Employment at Alto is limited to individuals residing in the following states: Connecticut, South Carolina, Tennessee, Oregon, Florida, Pennsylvania, Illinois, Kansas, Missouri, New Jersey, Washington, California, Nevada, Colorado, Texas, and New York.

Employment Requirement: Applicants must be authorized to work for any employer in the U.S. At this time, Alto is unable to sponsor or take over sponsorship of an employment Visa.

Benefits: Full-time: Medical, Dental, Vision, 401(k), Group Life, AD&D, Employer paid STD/LTD, generous PTO and parental leave.

Application deadline: July 15, 2024


#LI-Remote

Alto Pharmacy is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status, or any other legally protected basis.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.

To learn about Alto's privacy practices including compliance with applicable privacy laws, please click here