Senior Director – Payer Contracting

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

📋 Description

• Develop and implement payer strategies that align with market positioning, financial objectives, reimbursement priorities, growth targets, and organizational risk tolerance.

• Spearhead critical negotiations and renegotiations with both market and national health plans across fee-for-service and advanced value-based arrangements.

• Design and negotiate agreements for shared-savings, downside-risk, percent-of-premium, full-risk, transplant, high-cost drug, and provider-payer products.

• Oversee the entire contracting life cycle, from strategy and modeling through negotiation, implementation, performance monitoring, renewal, and escalation.

• Create analytic frameworks to assess reimbursement, contract yield, utilization, total cost of care, quality performance, attribution, risk adjustment, and financial exposure.

• Lead, mentor, and develop contracting professionals and analysts.

• Engage clinical, financial, legal, operational, and executive stakeholders to address competing priorities and achieve organization-wide outcomes.

• Enhance payer accountability and executive relationships while pinpointing opportunities for market expansion and innovative partnerships.

• Perform additional duties as assigned.

⛳️ Requirements

• A bachelor's degree in business, marketing, or a healthcare-related field.

• Ten years of experience in managed care within a payer or provider organization.

• Five years of experience in advanced value-based care or risk-based percent of premium management and negotiation in a payer or provider context.

• Proven track record of leading complex payer negotiations with substantial financial, operational, and market impacts.

• Extensive knowledge of reimbursement methodologies, contract analytics, value-based payment models, risk structures, managed care policies, and pertinent legal and regulatory factors.

• Demonstrated ability to lead teams and influence senior stakeholders in dynamic, highly matrixed environments.

• Proficient in communicating and exchanging precise information.

• Capable of maintaining a stationary position for extended durations.

• Ability to work with physical records or utilize a computer and other office equipment.

• In certain locations, willingness to travel throughout the hospital system.

• In specific locations, ability to lift up to 25 lbs.

• Adhere to standard precautions by using personal protective equipment as required for procedures.

• Employment offers are contingent upon testing for controlled substances.

• Must comply with the Cleveland Clinic Health System's influenza prevention program, including annual vaccination or an approved exemption.

🏝️ Benefits

• Annual influenza vaccination or an approved exemption under the influenza prevention program.

• Drug-free work environment.

• Equal employment opportunity.