Director of Payor Strategy – Value

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🔥 1 hour ago

🏄 California – Remote

🏄 California – Remote

💵 $140k - $160k / year

⏰ Full Time

🔴 Lead

🧐 Strategy

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ACES

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2005

🏥 Healthcare

⚕️ Healthcare Insurance

👥 B2C

Healthcare • Healthcare Insurance • B2C

ACES is a pioneering independent provider of NHS eye care services founded in 2005, operating community-based ophthalmology clinics. ACES offers routine and emergency outpatient eye services—especially cataract treatment—delivered by consultant ophthalmic surgeons using modern ophthalmic technology. They focus on timely care with short waiting times (cataract treatment in about four weeks), support NHS referral pathways, and emphasize patient-centered service across multiple community clinics.

📋 Description

• Co-architect and implement strategically valuable and economically sustainable payor strategies: Contracting roadmap for commercial payors, Medicaid MCOs, regional centers, school districts • Advance value-based and alternative payment models (P4P, bundles, outcomes-based arrangements), translating clinical quality and access metrics into defensible economic value • Develop state-specific payor playbooks for priority and emerging markets with Field/Growth Ops • Execute on payor strategy action plans, including building cross functional action plans that maintain or strengthen relationships with key payors • Set and manage to geography-specific payor-mix goals • Manage payor negotiations end-to-end, including rate setting, contract structure, escalators, carve-outs and amendments • Drive conversations with stakeholders for regular rate review and negotiation, bringing in senior executives to support when needed/additive • Report-outs on performance, opportunities and risk to executive team and key stakeholders • Ensure high-level engagement, leveraging ACES leaders to strategically enhance relationships • Identify and mitigate payor-related risk, including adverse policy changes, utilization management friction, denials and reimbursement erosion—proactively escalating and resolving issues • Partner with Data and Analytics team to forecast and evaluate the results of strategic options • Analyze trends for business opportunities and market clinical/business changes • Model rate changes and forecast payor mix impacts and profitability by payor; develop perspective on financial levers to pull through payor contracting, e.g. indirect hours impact, mid-tiers, overlaps, VBC, etc

🎯 Requirements

• Direct experience negotiating and structuring alternative reimbursement models and value-based care agreements (shared savings, risk corridors, quality-based bonuses, case rate/bundled models) • Has built partnerships and problem solved with a growth mindset to drive growth (volume, rate) • Operated intersection of strategy and payor relations — i.e., informed enterprise strategy (market entry, M&A targets, service line expansion) and executed it through contracts • Translated strategy into cross-functional, detailed action • Obsession for win-win value creation and translating ACES’ vision and purpose into growth to ensure ACES and payor return on investment • Fluent in translating company needs and clinical model with payors and visa versa • Creative thinker, problem solver and dot connecter to envision/capitalize on payor/employer solutions • Cross-functional collaborator; quickly builds trust and rapport • High learning agility with natural orientation to continuously improve results • Owner mentality who can make progress without significant support or direction • Bachelors or Master’s degree with 6-10 years experience in professional or multi-site healthcare business in strategic payor role strongly preferred • Alternative payment methodologies experience (e.g. pay for performance, value-based care) highly preferred with demonstrated track record/outcomes • 3-5 years demonstrated leadership and cross-functional experience, preferably within a payor team • High level organizational skills, with strong attention to detail • Curiosity: Listening and learning mindset • Distinguished interpersonal, communication (oral, written) and problem-solving skills • Professional selling skills – able to translate value of ACES clinical product/model to a Payor partner • Metrics-Driven: Strong accountability, with proven success in meeting timelines and deliverables • Applied behavior analysis (ABA) experience and related licensure a plus • Ability to travel as required.