Vice President – Head of Payer Strategy

🕒 Maio 29

🐊 Florida, New Jersey, +1 estados a mais – Remoto

🐊 Florida – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote

💵 $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

⚕️ Seguro de Saúde

📚 Educação

🧘 Bem-estar

Healthcare Insurance • Education • Wellness

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: UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, and Humana; serve as executive liaison to payer leadership at the C-suite and senior VP levels • Negotiate multi-year rate renewals, expand geographic coverage, and improve contract terms including facility fees, after-hours differentials, and coding/billing policies • Lead escalation management: resolve contract disputes, address network adequacy issues, and navigate audit and compliance challenges • Translate clinical quality, patient satisfaction, and cost-effectiveness into compelling payer value propositions • Analyze rate structures, benchmark against market, and identify opportunities for rate improvement • Align contract strategy with operational footprint, utilization patterns, and market expansion plans in partnership with SVP Urgent Care Operations • Accelerate behavioral health payer contracting in NY, NJ, and FL, and lead payer entry into 6+ new states over 24 months • Negotiate rates, terms, and coverage policies that support financial sustainability, with a target of $200K–$280K revenue per clinical FTE • Lead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs across multiple states; drive credentialing cycle time to under 45 days • Navigate state-specific contracting landscapes including Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies • Evaluate and build value-based care partnerships: shared savings, bundled payments, quality incentive programs, and outcomes-based contracts • Build payer performance dashboards tracking 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 scale the payer strategy function

🎯 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: rate improvements, contract wins, revenue growth • 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 • Executive presence: 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