Vice President – Head of Payer Strategy

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

📋 Description

• Manage strategic partnerships with Tier 1 payers and act as the executive liaison to payer leadership.

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

• Address contract disputes, network adequacy issues, audit challenges, and compliance matters.

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

• Examine rate structures, benchmark against market standards, and pinpoint opportunities for rate improvements.

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

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

• Oversee payer credentialing and network inclusion strategies for therapists, psychiatrists, and psychiatric NPs.

• Navigate Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies.

• Create and implement a behavioral health payer entry playbook.

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

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

• Develop clinical-financial frameworks and model upside/downside scenarios for value-based contracts.

• Position PM Pediatrics for new payment models and identify strategic payer partnership opportunities.

• Construct payer performance dashboards and benchmark rates and contract terms.

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

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

• Build and manage the payer strategy team.

• Generate a cumulative revenue impact of $15M–$25M.

⛳️ 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 roles (VP, SVP, or Director-level) with direct accountability for payer negotiations, contract performance, or network strategy.

• Demonstrated success in developing 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 with quantifiable results.

• Background in multi-site healthcare environments: 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 skills in financial modeling, contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment.

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

• Proven ability to translate payer strategy into revenue growth, margin enhancement, and optimization of payer mix.

• Experience in designing or negotiating value-based arrangements.

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

• Development of strategic partnerships beyond traditional contracting methods.

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

• Proven negotiation abilities in complex, multi-party situations.

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

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

• Preferred: experience in urgent care contracting, behavioral health contracting, pediatric healthcare, MBA/MHA/JD or equivalent advanced degree, top-tier healthcare strategy consulting, previous health plan experience, CMS or state Medicaid experience, and telehealth reimbursement expertise.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Competitive salary with performance-based bonuses.

• Generous paid time off and holidays.

• Retirement savings plan with company match.

• Professional development opportunities and continuing education support.