Position Summary:
The Director of Pharmacy Network Contracting & Public-Payer Relations reports to the Senior Vice President of Member & Community Relations of the Hemophilia Alliance. This role serves as an advisor and consultant to internal stakeholders, external partners, and member hemophilia treatment centers (HTCs), providing guidance on healthcare policy; 340B drug discount operations; and payer/Pharmacy Benefit Manager (PBM) coverage, utilization management, and reimbursement requirements impacting people living with bleeding disorders. The Director leads commercial pharmacy, PBM, and government-sponsored payer relations activities to support standardized, high-quality care and timely medication access and delivery. The role collaborates across Hemophilia Alliance departments and with external partners to support operational and clinical best practices, data reporting needs, prior authorization policy, and payer strategy. This position also supports the growth and sustainability of Hemophilia Alliance Network Services (HANS), including member HTC credentialing requirements and pharmacy policy agreements/contracting processes.
This role is well-suited for a mission-driven leader with broad pharmacy and healthcare policy experience who thrives in a fast-moving environment and can flex between detailed analysis and cross-functional project coordination within a virtual, matrixed team.
Key Responsibilities:
· Supports the mission of the Hemophilia Alliance: “The Hemophilia Alliance works to ensure member Hemophilia Treatment Centers (HTCs) have the expertise, resources and public support to sustain their integrated clinical and pharmacy services for individuals with bleeding and clotting disorders.”
· Works with and reports through the Director of Member & Community Relations team in identifying opportunities to allow HTCs the ability to dispense or distribute medications to their patients through the development of the Hemophilia Alliance Network Services (HANS) through single case agreements, and insurance payer contract negotiations.
· Leads and optimizes Hemophilia Alliance supported coordinated longitudinal clinical pharmacy operations across member HTCs, aligning workflows that strengthen patient access, care coordination with all levels of care, and service consistency while respecting local HTC practices and regulatory requirements.
· Provides and coordinates clinical reviews received to support the implementation of clinically supportable prior authorization process, including clear clinical rationale and explanation of hemophilia therapy selection (factor and non-factor products) as determined by evidence-based practice, aligned with sustainable provider healthcare reimbursement policies and unincumbered patient access to care.
· Create, implement, and coordinate the HANS credentialing program for pharmacies, including credentialing standards, application and review processes, re-credentialing cadence, issue remediation, quality assurance monitoring, and communication with member HTCs and pharmacy partners to support HANS PBM agreements and contracting processes.
· Partner with credentialing/enrollment contacts and member HTCs to ensure provider/pharmacy enrollment, revalidation, roster accuracy, and directory corrections across payers to protect patient access and HTC network access.
- Works collaboratively to gather data from members in conjunction with Member and Community Relations team members, the Payer Pricing Data Analyst, and Director Data Engineering & Operations to support HANS and Hemophilia Alliance payer initiatives ensuring data accuracy and timely submission.
- Support contract development with payers and PBMs through HANS, as well as member HTC reimbursement with government sponsored payers.
· Become the in-house Alliance subject matter expert (SME) for Medicare and Medicaid, monitoring policy updates and translating requirements into network workflows for coverage, authorizations, billing guidance, and payer communications as needed to support member HTCs and patient access.
· Monitor payer coverage criteria and utilization management requirements (e.g., prior authorization, reauthorization frequency, quantity limits, preferred products, specialty pharmacy mandates) and work with MCRs to translate them into HTC-friendly workflows, tools, or informational resources.
· Support development of payer-facing materials highlighting the HTC model of care with integrated pharmacy services to support coverage, network strategy, patient access and value-added narratives.
· Partner with HTC medical directors, nursing leaders, administrators, and HA committees to align operational priorities, escalate issues, and drive adoption of network standards, as well as update the product user guide.
· Maintain an understanding and remain current with the 340B Program rules, regulations and potential changes that may impact members.
· Participate in the development and implementation of programs aimed at HTC sustainability through growth of member HTC Pharmacy Programs including:
o Participate in managed care and commercial clinical and pharmacy contracting.
o Participate in Federal and State public payer initiatives.
o Participates in collaborative payer initiatives with patient advocacy organizations.
o Meets with key decision makers of payers, brokers, consultants, employers and governmental agencies to promote the member HTCs as Centers of Excellence.
o Participate in ongoing member payer education to strengthen member HTCs knowledge and effectiveness with payers.
· Work with confidential information (PHI and business) and use discretion when interacting with members, partners, manufacturers and the public.
· Maintain continuing education on patient privacy requirements.
· Public presentations at meetings and conferences as directed. Conduct video and phone conferences effectively and efficiently while using current technology on a variety of platforms.
· Commit to continuous learning and educating on how the Hemophilia Alliance supports the bleeding disorders community.
· Participate in the development and implementation of the Board approved annual strategic plan.
· Participates in Federal and State initiatives that affect the 340B program.
· Provides operational training, technical and regulatory guidance and assistance so HTCs can effectively manage and operate their pharmacy programs.
· Attends conferences and trade organization meetings as requested to stay current with market trends and promote HTCs as Centers of Excellence.
· Works with the Hemophilia Alliance GPO, Advocacy, Payer Relations, Membership, and Communication teams/consultants to provide operational support and assistance as necessary.
Required Skills & Qualifications:
- Pharmacist (PharmD) with a current, unrestricted license in at least one state, or equivalent clinical degree required and in good standing.
- Minimum of 5 years of professional experience in directly related areas.
· Demonstrated knowledge of hemophilia and bleeding disorders, either through direct work experience or active involvement in the bleeding disorders community.
· Understanding of the healthcare policy and marketing, including its business dynamics and trends.
· Familiarity with healthcare claims data, pharmacy benefits, payer contracts, patient analytic reporting, and group purchasing organizations (GPOs).
- Proven ability to work independently while also effectively contributing to virtual team environments.
- Excellent verbal, written and interpersonal communication skills; able to present data to both technical and non-technical audiences.
- Strong analytical, financial, and organizational skills to effectively manage responsibilities.
- Strong proficiency in Excel, databases, Microsoft, and similar visualization tools.
· Strong attention to detail and commitment to data quality and compliance (HIPAA familiarity preferred).
· Experience working with commercial and government-sponsored payers, as well as PBMs, on complex, high-cost therapies (e.g., coverage policy, prior authorization, appeals, denials, network strategy, clinical efficacy and performance reviews).
- Ability to interpret complex datasets and draw actionable insights for pricing and policy strategy.
- Project management experience and ability to juggle multiple priorities in a fast-paced, evolving environment.
- Eagerness to continually learn and acquire new knowledge, including a willingness to adapt to and incorporate new technologies.
- A personal presence defined by honesty, integrity, and empathy, with the ability to inspire and motivate others to support and advance the philosophy, vision, mission, goals, and values of the Hemophilia Alliance.
· Be highly motivated to accept other duties that arise because of changes in the bleeding disorders community and the healthcare arena.
Preferred Qualifications:
- Experience working in mission-based organizations.
- Understanding of the 340B drug pricing program and alternative pricing models. Hold a current 340 B ACE designation.
- Prior involvement in payer negotiations, rebate modeling, or specialty pharmacy analytics.
- Expert knowledge of state and national regulatory requirements, including FDA and related partners, for specialty pharmacy operations and ability to assess impacts of these policy requirements on agency and member pharmacy operations.
· Demonstrated expertise in Medicare and Medicaid coverage, policy, and reimbursement concepts (including policy interpretation, drafting and operationalization) for specialty therapies and related clinical services.
- Experience conducting comprehensive patient assessments and able to provide clinical reviews and treatment explanations that balance cost-effectiveness and benefit analysis with the most appropriate therapy and evidence proven efficacy while respecting member HTC practices and regulatory requirements.
· Experience in hematology/bleeding disorders, rare disease, specialty pharmacy, infusion, sterile compounding and other high-cost specialty care environments; experience supporting multi-site and multi-state clinical networks preferred.
· Direct experience with payer individual and network contracting support and/or payer performance programs for specialty/rare disease populations (including value-based or outcomes-based arrangements where applicable).
· Strong working knowledge of patient access and reimbursement for specialty therapies, including benefits investigation, prior authorization, clinical efficacy, appeals, and payer-driven site-of-care and specialty pharmacy requirements.
Working Conditions:
- Location: Remote office-based with required travel for meetings and events.
- Travel: Approximately 40% of the time traveling to HTCs, conferences, meetings/events, and advocacy events is expected. Must possess a valid driver’s license and be able to travel several times per month on average.
- Hours: Typically, 8am – 5pm, with occasional flexible hours for events and meetings.
- Physical Requirements: Ability to lift and carry up to 50 pounds.
Applicants are encouraged to submit a Cover Letter, in pdf, in addition to your resume.
Job Type: Full-time
Pay: $130,000.00 - $170,000.00 per year
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- Are you willing to undergo a drug screening test and a background check?
- Do you have knowledge of hemophilia and bleeding disorders, either through direct work experience or active involvement in the bleeding disorders community?
Willingness to travel:
Work Location: Remote
