Director, Payer Contracting

🔥 0 minutes ago

🌵 Arizona, Louisiana, +3 more states – Remote

🌵 Arizona – Remote ⚜️ Louisiana – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

⏰ Full Time

🔴 Lead

👔 Director

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Equality Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

☁️ SaaS

🤝 B2B

💰 Private equity on 2022-01

Healthcare • SaaS • B2B

Equality Health is a healthcare company that deploys a whole-person care model to help independent practices adopt and deliver value-based care for diverse communities. It provides technology (including a mobile app), care coordination, telemedicine support, and hands-on practice optimization to improve outcomes and practice performance under new payment models. The company focuses on social determinants of health, health equity, culturally competent care, risk management, and enabling providers and primary care networks to succeed in value-based arrangements.

📋 Description

• Support and assist in designing 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 • Position Equality Health as a preferred partner for value-based care delivery and population health management • Partner with finance, actuarial, clinical, and operations teams to ensure contracts are financially sound and operationally executable • Translate contract terms into performance expectations, KPIs, and reporting frameworks • Monitor medical cost trends, quality metrics, and risk adjustment outcomes • Lead renegotiations and contract optimizations based on performance insights • Collaborate with network development, provider relations, and clinical teams to align incentives and ensure provider readiness for risk-based models • Work with legal and compliance to structure contracts meeting regulatory requirements • Partner with finance and analytics teams on pricing, forecasting, and performance measurement • Support entry into new markets 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 cross-functionally operationalizing contracts in provider or payer organizations • Excellent negotiation, communication, and relationship management skills • Preferred: strong, trusted relationships with key Medicaid health plans • Preferred: background in a top-tier healthcare consulting firm such as McKinsey & Company, Bain & Company, or Boston Consulting Group • Preferred: strong analytical and financial modeling capabilities • Preferred: MBA, MHA, or related advanced degree

🏖️ Benefits

• Equal employment opportunities and nondiscrimination protections • Exempt classification