Vice President – Head of Payer Strategy

🕒 5 days ago

🐊 Florida, New Jersey, +1 more states – Remote

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

💵 $220k - $275k / year

⏰ Full Time

🔴 Lead

👔 Vice President

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PM Pediatric Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2005

⚕️ Healthcare Insurance

📚 Education

🧘 Wellness

Healthcare Insurance • Education • Wellness

PM Pediatric Care is a healthcare provider specializing in pediatric urgent care and comprehensive behavioral health services for children and young adults aged 5-26. The company offers convenient, top-quality, evidence-based medical care with services that include virtual visits, medication management, and psychiatric services. Additionally, PM Pediatric Care provides educational resources for parents and caregivers and works closely with schools to improve K-12 student outcomes with full-spectrum physical and mental health programs. They also have strategic partnerships with leading health systems and provide professional development for clinicians.

📋 Description

• 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

🎯 Requirements

• 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