VP, Managed Care Contracting

Coral is building a high-quality, cost-effective medical network serving community-based ambulatory infusion centers and multi-specialty providers. We are seeking a proven leader to launch and manage our medical-benefit-focused PSAO (Pharmacy Services Administrative Organization). This leader will own all aspects of payer strategy, analytics, and contracting for the medical benefit — with the goal of optimizing site-of-care and enabling in-network growth for Coral members. This is a unique opportunity to build from the ground up within a fast-moving and mission-driven healthcare organization.

Key Responsibilities

• PSAO Leadership & Strategy
  • Design and operationalize a Coral-branded PSAO for the medical benefit, targeting commercial and Medicare Advantage contracts.
  • Aggregate community-based infusion, home infusion, and multi-specialty providers under a single, Coral-aligned umbrella.
  • Develop payer narratives aligned with site-of-care redirection policies and evolving value-based frameworks.
• Payer Contracting & Negotiation
  • Lead contract negotiation with commercial, Medicare Advantage, and other managed care plans.
  • Structure master agreements and delegated contracting models on behalf of Coral members.
  • Navigate benefit design tradeoffs between pharmacy and medical benefits (white bagging vs. buy & bill).
  • Identify credentialing and assistance needs of providers to participate in payer networks and develop internal solutions or facilitating tools for providers.
• RCM & Payment Process
  • Develop working models for flow of funds between provider and payer within the PSAO model.
  • Ensure appropriate claim and financial reporting criteria and expectations are met between contracting entities.
  • Analytics & Performance Optimization.
  • Utilize payer claims data to identify contract performance variation by payer, drug, and service line.
  • Drive margin expansion via smarter fee schedules, updated J-code reimbursement, and proactive renegotiation.
  • Work with internal and external data teams to build dashboards on contract performance, rebate alignment, and site-of-care leakage.
• Cross-Functional Collaboration
  • Coordinate with Coral GPO, Coral Connect, and external vendors to align reimbursement with procurement strategy.
  • Partner with Member Success, Finance, and Clinical Ops to ensure Coral PSAO clients realize savings and access benefits.

Tools & Support

You’ll have access to:

• Contract modeling and performance dashboards
• Drug cost benchmarks from Coral GPO
• Rebate alignment tools and payer policy databases
• Support from Coral’s payer data team, finance, and provider partnerships
• Legal resources for contract development and negotiation support

Preferred Qualifications

• 7+ years of experience in managed care contracting, preferably within infusion, home health, or specialty care
• Deep understanding of medical benefit payer dynamics, site-of-care policies, HCPCS/J-code reimbursement, and buy-and-bill economics
• Solid operational understanding of provider environment including key processes of benefit verification investigation, prior authorization, and claims appeals to ensure drug access and payment
• Proven ability to negotiate with national payers and regional plans, including value-based models
• Familiarity with both pharmacy and medical benefits, and crossover management strategies
• Strong analytical skills; ability to interpret claims and contracting performance data to drive decisions
• Strategic thinker who can build a scalable PSAO platform in a fast-growth environment

Location

• Remote with travel to client locations, internal business meetings, and other locations as needed.