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, geographic coverage, facility fees, after-hours differentials, and coding/billing policies.

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

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

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

• Synchronize contract strategy with operational footprint, utilization trends, and market expansion initiatives.

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

• Negotiate behavioral health rates, terms, and coverage policies.

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

• Reduce credentialing cycle time to less than 45 days.

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

• Develop and implement a comprehensive behavioral health payer entry playbook.

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

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

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

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

• Direct cross-functional payer governance with RCM, Finance, and Operations.

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

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

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

⛳️ Requirements

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

• 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 building and leveraging executive relationships with Tier 1 payers such as UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, and Humana.

• Direct experience negotiating multi-million dollar payer contracts with measurable outcomes: rate improvements, contract successes, 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 regulations.

• Strong financial modeling skills: contract rate analysis, market benchmarking, revenue impact modeling, and assessments of financial risk in value-based care.

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

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

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

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

• Development of strategic partnerships beyond traditional contracting, including SDOH collaborations, pilot initiatives, and innovation projects.

• Ability to establish credibility with payer C-suite executives, internal leaders, and board members.

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

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

• Capacity 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, former health plan experience, CMS or state Medicaid experience, and expertise in telehealth reimbursement.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive healthcare coverage including medical, dental, and vision.

• Generous paid time off and holidays.

• Retirement savings plan with company matching.

• Opportunities for professional development and continuing education.