Director, Payer Contracting

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

📋 Description

• Develop and support innovative payer contract frameworks, including shared savings, downside risk, capitation, and bundled payment models.

• Align the contracting strategy with the organization's growth objectives, clinical models, and financial goals.

• Lead comprehensive negotiations with Medicaid managed care organizations and other payer collaborators.

• Maintain executive-level relationships with payer counterparts.

• Collaborate with finance, actuarial, clinical, operations, network development, provider relations, legal, compliance, and analytics teams to implement contracts.

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

• Monitor trends in medical costs, quality metrics, risk adjustment outcomes, and contract performance.

• Drive contract renegotiations and enhancements based on performance insights.

• Facilitate market entry by building payer relationships and obtaining Medicaid plan contracts.

• Identify avenues to broaden existing contracts to new populations, services, or regions.

• Provide updates to stakeholders regarding pipeline, contract status, and financial implications.

• Contribute to payer strategy and performance presentation materials.

⛳️ Requirements

• Associate’s degree or higher and/or equivalent experience in healthcare or a related field.

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

• Extensive knowledge of Medicaid managed care and value-based payment models.

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

• Strong grasp of healthcare economics, including medical cost drivers, risk adjustment, and quality incentives.

• Experience working with or contracting for Medicaid managed care organizations, MSOs, ACOs, or risk-bearing provider groups.

• Experience in multi-state Medicaid environments and familiarity with state-specific regulations.

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

• Exceptional negotiation, communication, and relationship management abilities.

• Preferred: Established relationships with key Medicaid health plans.

• Preferred: Previous experience at McKinsey & Company, Bain & Company, or Boston Consulting Group with a focus on healthcare.

• Preferred: Strong analytical and financial modeling skills.

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

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and advancement.

• Supportive work environment that values collaboration and innovation.