Director of Payor Strategy – Value

This is a fully remote position, open to applicants in California.

📋 Description

• Collaborate in designing and executing strategically significant and economically viable payor strategies, including a contracting roadmap for commercial payors, Medicaid MCOs, regional centers, and school districts.

• Promote value-based and alternative payment models (P4P, bundles, outcomes-based arrangements), converting clinical quality and access metrics into defensible economic value.

• Create state-specific payor playbooks for priority and emerging markets in partnership with Field/Growth Operations.

• Implement payor strategy action plans, including the development of cross-functional action plans that sustain or enhance relationships with key payors.

• Establish and oversee geography-specific payor-mix objectives.

• Manage payor negotiations from start to finish, encompassing rate setting, contract structure, escalators, carve-outs, and amendments.

• Facilitate discussions with stakeholders for regular rate reviews and negotiations, engaging senior executives for support when necessary.

• Provide reports on performance, opportunities, and risks to the executive team and key stakeholders.

• Ensure strong engagement, leveraging ACES leaders to strategically strengthen relationships.

• Identify and mitigate risks related to payors, including adverse policy changes, utilization management challenges, denials, and reimbursement erosion—proactively escalating and addressing issues.

• Collaborate with the Data and Analytics team to forecast and assess the outcomes of strategic options.

• Analyze trends for business opportunities and shifts in market clinical/business dynamics.

• Model rate changes and predict payor mix impacts and profitability by payor; develop insights on financial levers to optimize payor contracting, such as indirect hours impact, mid-tiers, overlaps, VBC, etc.

⛳️ Requirements

• Direct experience in negotiating and structuring alternative reimbursement models and value-based care agreements (shared savings, risk corridors, quality-based bonuses, case rate/bundled models).

• Proven ability to build partnerships and solve problems with a growth-oriented mindset to drive growth (volume, rate).

• Experience operating at the intersection of strategy and payor relations—i.e., informing enterprise strategy (market entry, M&A targets, service line expansion) and executing it through contracts.

• Ability to translate strategy into detailed, cross-functional action plans.

• A strong focus on win-win value creation, translating ACES’ vision and purpose into growth to ensure returns on investment for both ACES and payors.

• Proficient in articulating company needs and clinical models to payors and vice versa.

• A creative thinker and problem solver who connects dots to envision and leverage payor/employer solutions.

• A collaborative cross-functional team member who quickly establishes trust and rapport.

• High learning agility with a natural inclination towards continuous improvement.

• Exhibits an owner mentality, capable of making progress with minimal support or direction.

• Bachelor’s or Master’s degree with 6-10 years of experience in a professional or multi-site healthcare business in a strategic payor role is strongly preferred.

• Experience with alternative payment methodologies (e.g., pay for performance, value-based care) is highly preferred, along with a demonstrated track record of successful outcomes.

• 3-5 years of demonstrated leadership and cross-functional experience, ideally within a payor team.

• Exceptional organizational skills with a strong attention to detail.

• A curious mindset characterized by a willingness to listen and learn.

• Excellent interpersonal, communication (oral and written), and problem-solving skills.

• Professional selling skills—capable of conveying the value of ACES clinical products/models to payor partners.

• Metrics-driven with a strong sense of accountability, proven success in meeting timelines and deliverables.

• Experience in applied behavior analysis (ABA) and related licensure is a plus.

• Willingness to travel as required.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and career advancement.

• Supportive and inclusive workplace culture.