Director, Payer Relations

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description:

The Director, Payer Relations will report to OneOncology’s Vice President, Payer Relations. This role will be responsible for leading the strategy, negotiation, and management of Pharmacy Benefit Manager (PBM) contracts across OneOncology’s network of practices. This role ensures contracting strategies align with financial objectives, regulatory requirements, and organizational priorities. The Director serves as a subject matter expert, partnering with practice leadership and cross-functional teams to optimize reimbursement, resolve complex payer issues, and support value-based care initiatives. This position operates with a high degree of independence and may be responsible for building, leading, and developing a team as business needs evolve.

Responsibilities:

• Assures contractual arrangements are accurate and meet financial targets and legal/regulatory compliance requirements for all assigned PMB contracts.

• Negotiate contract language according to department standards to achieve favorable financial and operational outcomes.

• Proactively monitor PBM industry trends, reimbursement changes, and regulatory developments to identify potential risks and strategic contracting opportunities

• Support other departments to resolve chronic PBM specific payer issues related to assigned contracts as needed.

• Present at any practice facing meeting on PBM related topics as needed when approved by VP.

• Demonstrate expertise in PBM contracting and reimbursement to support internal decision-making as well as practice education as needed. Proactively identify educational needs and escalate issues to appropriate practice or OO leaders.

• Ability to work in a matrix environment where multiple and competing customer demands are likely.

• Focus on client satisfaction through internal and external communication.

• Partners with VP to develop annual team goals and budget targets and monitor progress towards established objectives.

• Independently create action plans for closing any team member performance gaps.

• Drives the development of assigned team members through coaching, feedback and professional development.

• Collaborate with VP to assess department tools and talent needs.

• Partner with VP to create and execute payer strategy for any market annually or as needed.

• Accomplishes department objectives by managing staff; driving negotiations, evaluating department activities and assisting VP in monitoring needs of the department.

• Create content and lead team meetings as necessary.

• Functions as a strategic leader with minimal oversight, proactively driving initiatives and identifying opportunities for improvement in alignment with the VP’s vision.

• Collaborate with VP on value-based care programs, alternative payment models or external partnerships that drive revenue for our practices.

• Additional responsibilities as assigned to help drive our mission of improving the lives of everyone living with cancer.

Qualifications:

• Bachelor’s degree required in business, finance, healthcare administration or other relevant fields. Master’s degree is preferred but not required.

• 5+ years of people management experience, preferably including experience leading remote teams.

• Minimum 8 years of relevant experience working with hospital, clinic, physician practice or healthcare system PBM contracting.

• Demonstrated knowledge and understanding of the legal and regulatory requirements in the healthcare industry as they relate to payer contracting and reimbursement.

• Current industry experience negotiating PBM contracts required, including contract terms, reimbursement methodologies and financial considerations.

• Current or previous payer contracting PBM experience preferred but not required.

• Ability to travel as needed to support business and practice needs.

• Demonstrated knowledge and deep understanding of contract language, including successful track record in negotiating language changes that support favorable financial and operational outcomes for practices.

• Demonstrated experience developing and executing contracting strategies, evaluating financial impacts, and influencing decisions across multiple stakeholders.

Essential Competencies:

• Ability to work with minimal supervision while maintaining alignment with team and organizational objectives.

• Excellent written and verbal communication skills.

• Strong negotiation and influencing skills.

• In-depth knowledge of Medicare, Medicaid, and commercial insurance.

• In-depth knowledge of the PBM space, drug reimbursement methodologies and analytics models.

• Demonstrate proficiency with financial reports and modeling to evaluate contracting opportunities and financial impacts.

• Experience in value-based care program development.

• Conflict resolution skills and strong relationship building skills.

• Strong attention to detail.

• Innovative problem solving and strong critical thinking skills with the ability to develop strategic recommendations.

• Ability to manage multiple complex projects and competing priorities simultaneously.

• Ability to coach, mentor, and develop team members while promoting accountability and continuous improvement.

• Strong business acumen with the ability to align PBM contracting strategies with organizational priorities and financial objectives.

• Attendance is an essential job function.

This job description does not contain a full listing of activities, duties or responsibilities required of this role. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

OneOncology was founded by community physicians, for community physicians, with the mission of improving the lives of everyone living with cancer and other diseases. Our goal is to enable community medical practices to remain independent and to improve patient access to care in their communities, all at a lower cost than in the hospital setting. OneOncology supports our platform of community medical practices through group purchasing, operational optimization, practice growth, and clinical innovation. Our partner practices comprise approximately 2,300+ providers who care for approximately 1.5 million patients across 20 states.