Director, Payer Contracting

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Equality Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

☁️ SaaS

⚕️ Healthcare Insurance

💰 Private equity on 2022-01

Healthcare • SaaS • Healthcare Insurance

Equality Health is simplifying value-based care and building pathways to better health outcomes for Medicaid and historically under-resourced communities. The company integrates data-driven technology (CareEmpower®), skilled practice coaching, and patient engagement to support providers, health plans, and members. Equality Health focuses on enabling equitable, value-based care through software, practice transformation, and partnerships with payers and providers to improve individual and population health outcomes.

📋 Description

• Design and support innovative payer contract structures, including shared savings, downside risk, capitation, and bundled payment models • Align contracting strategy with enterprise growth goals, clinical models, and financial targets • Lead end-to-end negotiations with Medicaid managed care organizations and other payer partners • Manage executive-level relationships with payer counterparts • Partner with finance, actuarial, clinical, operations, network development, provider relations, legal, compliance, and analytics teams to operationalize contracts • Translate contract terms into performance expectations, KPIs, and reporting frameworks • Monitor medical cost trends, quality metrics, risk adjustment outcomes, and contract performance • Lead contract renegotiations and optimizations based on performance insights • Support market entry by establishing payer relationships and securing Medicaid plan contracts • Identify opportunities to expand existing contracts to new populations, services, or geographies • Provide stakeholder updates on pipeline, contract status, and financial impact • Contribute to payer strategy and performance presentation materials

🎯 Requirements

• Associate’s degree or higher and/or equivalent experience in a healthcare or related field of study • 10+ years of experience in payer contracting, network management, or healthcare business development • Deep expertise in Medicaid managed care and value-based payment models • Proven track record negotiating and managing complex, risk-based contracts • Strong understanding of healthcare economics, including medical cost drivers, risk adjustment, and quality incentives • Experience working with or contracting on behalf of Medicaid managed care organizations, MSOs, ACOs, or risk-bearing provider groups • Experience in multi-state Medicaid environments and familiarity with state-specific regulations • Experience operationalizing contracts cross-functionally in provider or payer organizations • Excellent negotiation, communication, and relationship management skills • Preferred: strong relationships with key Medicaid health plans • Preferred: background in McKinsey & Company, Bain & Company, or Boston Consulting Group with healthcare focus • Preferred: strong analytical and financial modeling capabilities • Preferred: MBA, MHA, or related advanced degree