Head of Payor Strategy

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

📋 Description

• Manage relationships with Medicaid Managed Care Organizations, Medicare Advantage plans, and commercial health plan partners in both existing and targeted markets.

• Oversee contract negotiations for new market entries, rate adjustments, and the establishment of value-based program frameworks.

• Develop and implement the company's payor strategy: prioritize plans, determine terms, and establish market entry sequences.

• Construct the payor infrastructure from the ground up, including reporting schedules, performance dashboards, quality monitoring, and analytics for plans.

• Collaborate with clinical leadership to craft and communicate an outcomes narrative that aligns with the interests of health plans.

• Partner with finance to analyze contract economics, validate rate assumptions, and safeguard margins at scale.

• Represent Abby Care at health plan meetings, state conferences, and industry events.

⛳️ Requirements

• Proven experience in defining an organization's health plan strategy—either from the plan side (network strategy, provider contracting, government programs, or consulting) or the operational side (Director/VP of Payor Strategy, Head of Commercial, CRO, or similar roles in a digital health company).

• Demonstrated success in negotiating and finalizing contracts with Medicaid Managed Care Organizations, Medicare Advantage plans, or commercial insurers.

• In-depth understanding of how plans purchase, contract, and assess performance: including PMPM and FFS rate structures, authorization processes, value-based care agreements, and quality measurement frameworks (HEDIS, CAHPS, state-specific KPIs).

• Familiarity with the regulatory and contracting landscape for home-based care services or a proven ability to quickly acquire deep domain expertise.

• Capacity to collaborate across internal teams (clinical, finance, product, legal) and act as a bridge between our offerings and what plans are willing to reimburse.

• We are open to various titles and levels of experience; what is essential is your history of negotiating and closing significant deals with health plans and the ability to demonstrate the outcomes.

🏝️ Benefits

• Competitive compensation packages that reflect the value you contribute. We recognize our team for their impact—full-time employees are eligible for an annual company performance bonus.

• Comprehensive health benefits tailored to your needs. Options include high-quality medical, dental, and vision plans, featuring a $0 deductible PPO and a company-funded HSA, as well as employer-paid life and disability insurance.

• Generous paid time off policy. We offer time off to help you recharge, plus 10 paid company holidays.

• Financial benefits to support your future. We enhance your financial well-being with HSA contributions, optional FSA and commuter benefits, and full coverage of all 401(k) account fees (employer match not currently offered).

• Paid parental leave to help you as your family grows. We offer paid leave to allow you to focus on bonding and transitioning into your new family life.