Vice President – Head of Payer Strategy

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

📋 Description

• Manage strategic relationships with Tier 1 payers and act as the executive liaison to payer leadership at the C-suite and senior VP levels.

• Negotiate multi-year rate renewals, broaden geographic coverage, and enhance contract terms, including facility fees, after-hours differentials, and coding/billing policies.

• Resolve contract disputes, tackle network adequacy issues, and navigate audit and compliance challenges.

• Convert clinical quality, patient satisfaction, and cost-effectiveness into compelling payer value propositions.

• Analyze rate structures, benchmark against market standards, and identify opportunities for rate enhancements.

• Align contract strategies with operational footprints, utilization patterns, and market expansion initiatives.

• Expedite behavioral health payer contracting in NY, NJ, and FL, while spearheading payer entry into over 6 new states within 24 months.

• Negotiate rates, terms, and coverage policies that support financial sustainability.

• Lead the payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs across various states.

• Navigate state-specific contracting environments, including Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies.

• Develop and implement a behavioral health payer entry playbook.

• Evaluate and establish value-based care partnerships, including shared savings, bundled payments, quality incentive programs, and outcomes-based contracts.

• Lead strategic payer pilots that involve integrated care models, SDOH collaborations, pediatric behavioral health integration, and alternative reimbursement frameworks.

• Design clinical-financial frameworks for value-based arrangements and model both upside and downside scenarios.

• Position PM Pediatrics for emerging payment models, including CMS Innovation Center initiatives and Medicaid value-based purchasing.

• Identify strategic payer partnership opportunities that involve data sharing, care coordination platforms, and referral network integrations.

• Create payer performance dashboards and benchmark rates and contract terms against industry competitors.

• Lead cross-functional payer governance involving RCM, Finance, and Operations.

• Develop negotiation playbooks, contract templates, and rate benchmarking tools.

• Build and lead the payer strategy team as the organization scales.

• Drive a cumulative revenue impact of $15M–$25M through contract optimization, new payer partnerships, and value-based upside.

• Report to the Chief Commercial Officer and collaborate with Operations, Clinical Programs, Finance/FP&A, and Revenue Cycle Management.

• Interact with the CEO, Board of Directors, and national payer C-suites.

⛳️ Requirements

• 10+ years of experience in healthcare payer strategy, network contracting, or health plan partnerships with increasing levels of responsibility.

• 5+ years in senior leadership positions (VP, SVP, or Director-level) with direct accountability for payer negotiations, contract performance, or network strategy.

• Proven capability in building and leveraging executive-level relationships with UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, Humana, or similar Tier 1 payers.

• Direct experience negotiating multi-million dollar payer contracts yielding measurable results such as rate improvements, contract wins, and revenue growth.

• Experience in multi-site healthcare environments: urgent care, behavioral health, outpatient specialty, or retail healthcare.

• Multi-state contracting experience, including Medicaid managed care, telehealth reimbursement policies, and regional BCBS plans.

• Expertise in provider credentialing: CAQH, payer enrollment processes, and multi-state licensure requirements.

• Strong financial modeling skills, including contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment.

• Proficiency with payer analytics, claims data, utilization reports, and contract performance dashboards.

• Demonstrated ability to translate payer strategy into revenue growth, margin improvement, and payer mix optimization.

• Experience in designing or negotiating value-based arrangements: shared savings, bundled payments, quality incentives, outcomes-based contracts, or population health models.

• Familiarity with clinical quality metrics: HEDIS, NCQA, patient satisfaction, clinical outcomes, and cost-effectiveness.

• Strategic partnership development experience that goes beyond traditional contracting: SDOH collaborations, pilot programs, and innovation initiatives.

• Ability to build credibility with payer C-suites, internal executives, and board members.

• Proven negotiation skills in complex, multi-party scenarios.

• Strong written, verbal, and presentation skills for executive reporting and board-level updates.

• Capability to lead cross-functionally across Operations, Clinical, Finance, and RCM without direct authority.

• An MBA, MHA, JD, or an equivalent advanced degree is preferred.

• Preferred qualifications include urgent care contracting experience, behavioral health contracting, pediatric healthcare, prior consulting experience, former health plan experience, CMS or state Medicaid experience, and telehealth reimbursement expertise.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health benefits package.

• Opportunities for professional growth and development.

• Collaborative work environment with a focus on innovation.

• Flexible work arrangements to support work-life balance.