Vice President – Head of Payer Strategy

🕒 vor 2 Monaten

🐊 Florida, New Jersey, +1 weitere Bundesländer – Remote

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

💵 $220.000 - $275.000 / Jahr

⏰ Vollzeit

🔴 Experte

👔 Vizepräsident

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PM Pediatric Care

WebsiteLinkedInAlle Stellen

501 - 1000 Mitarbeiter

Gegründet 2005

🏥 Gesundheitswesen

⚕️ Krankenversicherung

📚 Bildung

Healthcare • Healthcare Insurance • Education

PM Pediatric Care ist ein Gesundheitsdienstleister, der sich auf die pädiatrische Notfallversorgung und umfassende Verhaltensgesundheitsdienste für Kinder und junge Erwachsene im Alter von 5 bis 26 Jahren spezialisiert hat. Das Unternehmen bietet bequeme, qualitativ hochwertige und evidenzbasierte medizinische Versorgung an, einschließlich virtueller Besuche, Medikamentenmanagement und psychiatrischer Dienste. Darüber hinaus stellt PM Pediatric Care Bildungsressourcen für Eltern und Betreuer zur Verfügung und arbeitet eng mit Schulen zusammen, um die Ergebnisse für Schüler der Klassen K-12 mit umfassenden physischen und psychischen Gesundheitsprogrammen zu verbessern. Sie haben auch strategische Partnerschaften mit führenden Gesundheitssystemen und bieten professionelle Entwicklungsmöglichkeiten für Kliniker.

Beschreibung

• 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

🎯 Anforderungen

• 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