Director Utilization Management Jobs in Decatur, GA

Director of Payor Contracting - Infusion

Location: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement Alternate locations may be considered.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Director Payor Contracting directs the enterprise payor contracting strategy for an infusion pharmacy organization and ensures that standardized and approved processes are utilized for payor relationship management, contract negotiation, network participation strategy, and reimbursement optimization across commercial, Medicare, Medicaid, and employer-sponsored plans, with a primary focus on medical benefit contracting and site-of-care infusion models.

How you will make an impact:

• Develops and leads a comprehensive contracting strategy aligned with growth goals across home infusion, ambulatory infusion centers (AICs), and site-of-care optimization strategies within the medical benefit.

• Serves as a strategic advisor to executive leadership on health plan contracting trends, medical benefit reimbursement risk, site-of-care shifts, and evolving regulatory/CMS considerations impacting infusion services.

• Leads complex negotiations with national and regional health plans and government payors, including reimbursement methodologies (e.g., ASP, AWP, WAC, per diem, case rates), utilization management requirements, and infusion-specific carve-outs.

• Oversees contract modeling, financial impact analysis, approval governance, and ongoing performance monitoring to ensure contracts meet margin, growth, and operational feasibility given the complexity and longer lifecycle of infusion services.

• Partners with finance, operations, and clinical teams to evaluate reimbursement methodologies and ensure contracts support site-of-care delivery models, nursing services, prior authorization workflows, and patient access timelines.

• Acts as the primary liaison between contracting and internal stakeholders including operations, revenue cycle, clinical leadership, legal/compliance, and reporting, ensuring infusion contracts are executable across clinical and billing workflows.

• Leads, mentors, and develops a team of payor contracting professionals and contract managers, including oversight of credentialing, licensure, and audit readiness functions tied to infusion contracts.

• Ensures contracting activities align with federal and state regulations, CMS requirements, and health plan audit expectations, including compliance with Medicare Part B, Medicaid, and site-of-care guidelines.

Minimum Requirements:

Requires a Bachelor's degree and minimum of 10 years of experience in payor contracting, reimbursement, or managed care within specialty pharmacy, infusion services, PBM, or health plan environments, including demonstrated success leading complex national and regional negotiations and proven people leadership experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

• MBA/advanced degree with experience in infusion services, home infusion, ambulatory infusion centers (AICs), and strong understanding of Medicare Part B, Medicaid, and commercial medical benefit reimbursement preferred.

• Proven experience negotiating with national and regional health plans for infusion services, including site-of-care strategy, utilization management, and complex medical benefit contracting preferred.

• Deep understanding of infusion reimbursement methodologies (ASP, AWP, WAC, per diem, case rates) and their impact on margin, operations, and clinical delivery models preferred.

• Experience supporting credentialing, licensure, Board of Pharmacy requirements, audit readiness, and compliance with CMS and health plan guidelines within infusion contracting preferred.

• Demonstrated ability to lead larger contracting teams and manage complex, longer-cycle negotiations and payer escalations preferred.

• Strong cross-functional leadership, problem-solving, and executive communication skills with experience influencing senior stakeholders and driving strategy in fast-paced, complex environments preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $165,120 to $247,680.

Locations:Virginia

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.