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Senior Director, Payer Programs - Health and Wellness

Walmart

Walmart

Sales & Business Development
Bentonville, AR, USA
Posted on Friday, June 14, 2024

Position Summary...

What you'll do...

This role will be responsible for coordinating strategic negotiation planning, including conducting industry and payer research, supporting retail and specialty pharmacy negotiations and new business development. This role will also involve developing and maintaining relationships with key internal and external stakeholders (industry and governmental), negotiating pricing and drafting agreement terms, drafting policies and procedures, conducting root cause analysis, and ensuring compliance with regulatory requirements and industry standards.

You'll sweep us off our feet if:

  • You have experience with managing and overseeing aspects of provider or pharmacy benefit manager (PBM) operations, contracting, claims management, enrollment, and/or provider databases.
  • You have a strong understanding of health plan/PBM and provider managed care principals.
  • You are experienced with negotiating provider agreements (retail pharmacy and/or specialty pharmacy).
  • You possess excellent communication and organization skills.
  • You have the ability to develop and analyze operational metrics.

Additional responsibilities:

Directs teams in the coordination of implementation activities for new accounts and/or large-scale upgrades to existing accounts by

  • implementing activities (for example, scoping, budgeting, planning, documenting, reporting)
  • coordinating with the broader Health and Wellness business unit when required
  • overseeing a team that provides customer support during the implementation process
  • ensuring that all stakeholders are kept informed regarding project status and progress
  • ensuring implementation is completed and defined objectives for the implementation are achieved
  • capturing best practices from successful implementations and applying to other accounts, implementations, or contract negotiations.


Directs implementation of core payer program processes by

  • overseeing negotiations and re-negotiations of contractual programs
  • executing additional implementation and post-implementation requirements (for example, ensuring collections, terminations, pricing, and eligibility are set up and handled)
  • identifying opportunities to streamline or improve the implementation and post-implementation processes.


Directs quality assurance processes and work flows by

  • creating and maintaining quality assurance processes and procedures
  • establishing system checks to ensure accuracy of eligibility and billing systems.


Builds, manages, and owns relationships with outside vendors by

  • monitoring and tracking vendor reports and reimbursement rates to ensure claims are processed
  • identifying opportunities for system modifications
  • evaluating new vendors, providing vendor recommendations to management.

Oversees risk mitigation for government and commercial payers and ensures compliance with federal and state regulatory requirements and company standards for supporting programs by

  • conducting evaluations of current and future contracts and guidelines to assess short and long-term change requirements.

Provides overall direction by

  • analyzing business objectives and customer needs
  • developing, communicating, building support for, and implementing business strategies, plans, and practices
  • analyzing costs and forecasts and incorporating them into business plans
  • determining and supporting resource requirements
  • evaluating operational processes
  • measuring outcomes to ensure desired results
  • identifying and capitalizing on improvement opportunities
  • promoting a customer environment
  • demonstrating adaptability and sponsoring continuous learning.

Develops and implements strategies to attract and maintain a highly skilled and engaged workforce by

  • diagnosing capability gaps
  • recruiting, selecting, and developing talent
  • supporting mentorship, workforce development, and succession planning
  • leveraging the capabilities of new and existing talent.

Cultivates an environment where associates respect and adhere to company standards of integrity and ethics by

  • integrating these values into all programs and practices
  • developing consequences for violations or non-compliance
  • supporting the Open Door Policy.

Develops and leverages internal and external partnerships and networks to maximize the achievement of business goals by

  • sponsoring and leading key community outreach and involvement initiatives
  • engaging key stakeholders in the development, execution, and evaluation of appropriate business plans and initiatives
  • supporting associate efforts in these areas.

#LI-MF4

Live our Values

Culture Champion

• Models the Walmart values to foster our culture; holds oneself and others accountable; and supports Walmart’s commitment to communities, social justice, corporate social responsibility, and sustainability; maintains and promotes the highest standards of integrity, ethics and compliance.

Servant Leadership

• Acts as an altruistic servant leader and is consistently humble, self-aware, honest, and transparent.

Embrace Change

Curiosity & Courage

• Demonstrates curiosity and a growth mindset; fosters an environment that supports learning, innovation, and intelligent risk-taking; and exhibits resilience in the face of setbacks.

Digital Transformation & Change

• Seeks and implements continuous improvements and encourages the team to leverage new digital tools and ways of working.

Deliver for the Customer

Customer Focus

• Delivers expected business results while putting the customer first and consistently applying an omni-merchant mindset and the EDLP and EDLC business models to all plans.

Strategic Thinking

• Adopts a holistic perspective that considers data, analytics, customer insights, and different parts of the business when making plans and shaping the team’s strategy.

Focus on our Associates

Diversity, Equity & Inclusion

• Identifies, attracts, and retains diverse and inclusive team members; builds a high-performing team; embraces diversity in all its forms; and actively supports diversity goal programs.

Collaboration & Influence

• Builds strong and trusting relationships with team members and business partners; works collaboratively and cross-functionally to achieve objectives; and communicates with energy and positivity to motivate, influence, and inspire commitment and action.

Talent Management

• Creates a discipline and focus around developing talent, promotes an environment allowing everyone to bring their best selves to work, empowers associates and partners to act in the best interest of the customer and company, and regularly recognizes others’ contributions and accomplishments.

At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.

You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.

For information about PTO, see https://one.walmart.com/notices.

Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.

For information about benefits and eligibility, see One.Walmart.

The annual salary range for this position is $160,000.00-$320,000.00

Additional compensation includes annual or quarterly performance bonuses.

Additional compensation for certain positions may also include:

- Stock

Minimum Qualifications...

Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.

Minimum Qualifications: Bachelor’s degree and 6 years’ experience in billing, healthcare, legal, or related area OR 8 years’ experience in billing, healthcare, legal, or related area. 3 years’ supervisory experience.

Preferred Qualifications...

Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.

Contract Management, Working in or with Pharmacy Benefit Management Masters: Finance, Masters: Healthcare

Primary Location...

2501 Se J Street Ste B, Bentonville, AR 72712-7761, United States of America