Vice President – Head of Payer Strategy

This is a fully remote position, open to applicants in Florida, +2 more states.

📋 Description

• Manage strategic partnerships with Tier 1 payers: UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, and Humana; act as the executive liaison to payer executives at the C-suite and senior VP levels.

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

• Direct escalation management: resolve contract disputes, tackle network adequacy challenges, and navigate audit and compliance issues.

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

• Analyze rate structures, benchmark against the market, and pinpoint opportunities for rate enhancement.

• Align contract strategy with operational footprint, utilization trends, and market expansion initiatives in collaboration with SVP of Urgent Care Operations.

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

• Negotiate rates, terms, and coverage policies that promote financial sustainability, aiming for $200K–$280K revenue per clinical FTE.

• Direct payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs across various states; reduce credentialing cycle time to under 45 days.

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

• Assess and foster value-based care partnerships: shared savings, bundled payments, quality incentive programs, and outcomes-based contracts.

• Create payer performance dashboards to monitor contract utilization, revenue per contract, payer mix, claims denial rates, and financial performance by payer.

• Develop negotiation playbooks, contract templates, and rate benchmarking tools to enhance the payer strategy function.

⛳️ Requirements

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

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

• Demonstrated success in establishing and utilizing executive-level relationships with UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, Humana, or comparable Tier 1 payers.

• Direct experience in negotiating multi-million dollar payer contracts with quantifiable results: rate enhancements, contract successes, revenue growth.

• Familiarity with multi-site healthcare settings: urgent care, behavioral health, outpatient specialty, or retail healthcare.

• Experience with multi-state contracting, 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: contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment.

• Proficient in payer analytics, claims data, utilization reports, and contract performance dashboards.

• Executive presence: ability to establish credibility with payer C-suite executives, internal leaders, and board members.

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

• Excellent written, verbal, and presentation skills for executive reporting and board-level communications.

🏝️ Benefits

• Comprehensive health insurance plans.

• Generous retirement savings options.

• Flexible working environment.

• Opportunities for professional development and growth.

• Competitive compensation package.