Vice President – Head of Payer Strategy

🕒 Setembro 4

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $220.000 - $275.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Vice-presidente

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PM Pediatric Care

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2005

🏥 Saúde

⚕️ Seguro de Saúde

📚 Educação

Healthcare • Healthcare Insurance • Education

A PM Pediatric Care é um provedor de saúde especializado em atendimento pediátrico de urgência e serviços abrangentes de saúde comportamental para crianças e jovens adultos de 5 a 26 anos. A empresa oferece atendimento médico conveniente, da mais alta qualidade e baseado em evidências, com serviços que incluem visitas virtuais, gerenciamento de medicamentos e serviços psiquiátricos. Além disso, a PM Pediatric Care fornece recursos educacionais para pais e cuidadores e trabalha em estreita colaboração com escolas para melhorar os resultados dos alunos do ensino fundamental e médio com programas integrais de saúde física e mental. Eles também têm parcerias estratégicas com os principais sistemas de saúde e oferecem desenvolvimento profissional para clínicos.

Descrição

• Own strategic relationships with Tier 1 payers and serve as executive liaison to payer leadership • Negotiate multi-year rate renewals, geographic coverage, facility fees, after-hours differentials, and coding/billing policies • Resolve contract disputes, network adequacy issues, audit challenges, and compliance challenges • Translate clinical quality, patient satisfaction, and cost-effectiveness into payer value propositions • Analyze rate structures, benchmark against market, and identify rate improvement opportunities • Align contract strategy with operational footprint, utilization patterns, and market expansion plans • Accelerate behavioral health payer contracting in NY, NJ, and FL and lead payer entry into 6+ new states over 24 months • Lead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs • Navigate Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies • Design and execute a behavioral health payer entry playbook • Evaluate and build value-based care partnerships, including shared savings, bundled payments, quality incentives, and outcomes-based contracts • Lead strategic payer pilots involving integrated care, SDOH collaborations, pediatric behavioral health integration, and alternative reimbursement models • Design clinical-financial frameworks and model upside/downside scenarios for value-based contracts • Position PM Pediatrics for emerging payment models and identify strategic payer partnership opportunities • Build payer performance dashboards and benchmark rates and contract terms • Lead 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 • Drive $15M–$25M in cumulative revenue impact

🎯 Requisitos

• 10+ years in healthcare payer strategy, network contracting, or health plan partnerships with progressive responsibility • 5+ years in senior leadership roles (VP, SVP, or Director-level) with direct accountability for payer negotiations, contract performance, or network strategy • Proven track record of building and leveraging executive-level relationships with UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, Humana, or equivalent Tier 1 payers • Direct experience negotiating multi-million dollar payer contracts with measurable results • Experience in multi-site healthcare settings: urgent care, behavioral health, outpatient specialty, or retail healthcare • Multi-state contracting experience including Medicaid managed care, telehealth reimbursement policies, and regional BCBS plans • Provider credentialing expertise: CAQH, payer enrollment processes, and multi-state licensure requirements • Strong financial modeling, contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment • Comfort 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 designing or negotiating value-based arrangements • Familiarity with HEDIS, NCQA, patient satisfaction, clinical outcomes, and cost-effectiveness • Strategic partnership development beyond traditional contracting • Executive presence and ability to build credibility with payer C-suites, internal executives, and board members • Proven negotiation skills in complex, multi-party situations • Strong written, verbal, and presentation skills for executive reporting and board-level updates • Ability to lead cross-functionally across Operations, Clinical, Finance, and RCM without direct authority • Preferred: 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 telehealth reimbursement expertise