Director, Payor Contracting – Population Health

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

📋 Description

• Oversee managed care negotiations and maintain relationships with payors, focusing on reimbursement rates, administrative requirements, language, and terms.

• Act as the primary contact for payors regarding contracting escalations, disputes, innovative business collaborations, and direct engagements.

• Evaluate macro trends and market-specific details to uncover opportunities by market and payor.

• Create proposals to meet objectives related to rates, prior authorization pass/gold-carding, and population health incentives.

• Analyze health plan agreements and fee schedules of acquisition targets.

• Develop integration strategies to maximize stakeholder value.

• Represent Retina Consultants of America and regional teams during national managed care and intermediary negotiations.

• Maintain the contract management platform with all agreements and fee schedules.

• Collaborate with Financial Planning and Analytics to assess financial impacts and formulate budgets.

• Track and report on market trends, relative pricing, health plan trends, and opportunities for revenue enhancement.

• Create and implement strategies for underperforming program contracts, focusing on improvements in denials and underpayments.

• Prepare reporting and analytics to support recommendations for both internal and external stakeholders.

⛳️ Requirements

• Bachelor’s Degree in accounting, finance, or business administration.

• Over 5 years of experience in contracting, negotiations, and managing health plan portfolios within specialty medicine, private equity, or healthcare contracting.

• Extensive knowledge of the healthcare sector, including payer-provider relationships, analytics, and the alignment of incentives.

• Proven experience in a fast-paced, high-growth, high-pressure, and continuously changing environment.

• Strong analytical abilities and a keen attention to detail, accuracy, and accountability.

• Capability to manage health plan relationships effectively during negotiations.

• Proficient in leveraging data, insights, and communication strategies to influence stakeholders and accomplish business goals.

• Strong attention to detail and the ability to prioritize data in decision-making processes.

• Skilled in building constructive relationships.

• Ability to manage collaborative, matrix relationships throughout the organization.

• Excellent interpersonal skills for working with cross-functional teams and executives.

• Outstanding written and verbal communication skills, along with a strong executive presence.

• Ability to work hands-on with a sense of urgency and deliver high-quality work in a dynamic, rapidly expanding company.

🏝️ Benefits

• Medical, dental, and vision care.

• Backup dependent care.

• Adoption assistance.

• Infertility coverage.

• Family building support.

• Behavioral health solutions.

• Paid parental leave.

• Paid caregiver leave.

• Training programs.

• Professional development resources.

• Mentorship programs.

• Employee resource groups.

• Volunteer activities.

• Reasonable accommodations during the employment process.