Director, Payer Contracting

This is a fully remote position, open to applicants in Arizona, +4 more states.

📋 Description

• Provide support and assistance in the design of innovative payer contract structures, such as shared savings, downside risk, capitation, and bundled payment models.

• Ensure the contracting strategy aligns with enterprise growth objectives, clinical models, and financial goals.

• Oversee comprehensive negotiations with Medicaid managed care organizations and other payer partners.

• Maintain and manage executive-level relationships with payer counterparts.

• Establish Equality Health as a preferred partner for value-based care delivery and population health management.

• Collaborate with finance, actuarial, clinical, and operations teams to confirm that contracts are financially viable and operationally feasible.

• Convert contract terms into performance expectations, KPIs, and reporting frameworks.

• Track medical cost trends, quality metrics, and risk adjustment outcomes.

• Lead renegotiations and contract optimizations based on performance insights.

• Work alongside network development, provider relations, and clinical teams to align incentives and ensure provider readiness for risk-based models.

• Collaborate with legal and compliance teams to structure contracts that meet regulatory standards.

• Partner with finance and analytics teams on pricing strategies, forecasting, and performance evaluation.

• Facilitate entry into new markets by establishing payer relationships and securing Medicaid plan contracts.

• Identify opportunities to broaden existing contracts to include new populations, services, or geographical areas.

• Provide updates to stakeholders on pipeline status, contract progress, and financial impacts.

• Contribute to the development of payer strategy and performance presentation materials.

⛳️ Requirements

• An associate’s degree or higher and/or equivalent experience in a healthcare or related field of study.

• Over 10 years of experience in payer contracting, network management, or healthcare business development.

• Extensive expertise in Medicaid managed care and value-based payment frameworks.

• Demonstrated success in negotiating and managing complex, risk-based contracts.

• Strong knowledge of healthcare economics, including factors influencing medical costs, risk adjustment, and quality incentives.

• Experience working with or negotiating on behalf of Medicaid managed care organizations, MSOs, ACOs, or risk-bearing provider groups.

• Familiarity with multi-state Medicaid environments and state-specific regulations.

• Experience in operationalizing contracts across functions within provider or payer organizations.

• Exceptional negotiation, communication, and relationship management abilities.

• Preferred: established, trusted relationships with key Medicaid health plans.

• Preferred: experience with a leading healthcare consulting firm such as McKinsey & Company, Bain & Company, or Boston Consulting Group.

• Preferred: strong analytical and financial modeling skills.

• Preferred: MBA, MHA, or a related advanced degree.

🏝️ Benefits

• Equal employment opportunities and nondiscrimination protections.

• Exempt classification.