Vice President – Head of Payer Strategy

Job not on LinkedIn

🔥 27 minutes ago

🇺🇸 United States – Remote

💵 $220k - $275k / year

⏰ Full Time

🔴 Lead

👔 Vice President

👻 Ghost score 8%

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Ohio Chapter, American Academy of Pediatrics (Ohio AAP)

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 1934

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Ohio Chapter, American Academy of Pediatrics (Ohio AAP) is dedicated to educating and advocating for the health and well-being of children and adolescents in Ohio. The organization offers resources, training, and advocacy actions aimed at improving pediatric care, promoting vaccination, and addressing key health issues in the community. They also facilitate engagement among healthcare providers and families through various educational programs and initiatives focused on child health.

📋 Description

• Own strategic relationships with Tier 1 payers and 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 • Resolve contract disputes, address network adequacy issues, and navigate audit and compliance challenges • Translate clinical quality, patient satisfaction, and cost-effectiveness into payer value propositions • Analyze rate structures, benchmark against the market, and identify opportunities for rate improvement • Align contract strategy with operational footprint, utilization patterns, and market expansion plans • 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 supporting financial sustainability • Lead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs across multiple states • Navigate state-specific contracting landscapes including Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies • Design and execute a behavioral health payer entry playbook • Evaluate and build value-based care partnerships, including shared savings, bundled payments, quality incentive programs, and outcomes-based contracts • Lead strategic payer pilots involving integrated care models, SDOH collaborations, pediatric behavioral health integration, and alternative reimbursement models • Design clinical-financial frameworks for value-based arrangements and model upside/downside scenarios • Position PM Pediatrics for emerging payment models, including CMS Innovation Center initiatives and Medicaid value-based purchasing • Identify strategic payer partnership opportunities involving data sharing, care coordination platforms, and referral network integrations • Build payer performance dashboards and benchmark rates and contract terms against competitors • Lead cross-functional payer governance with RCM, Finance, and Operations • Develop negotiation playbooks, contract templates, and rate benchmarking tools • Build and lead the payer strategy team as the organization scales • Drive $15M–$25M in cumulative revenue impact through contract optimization, new payer partnerships, and value-based upside • Report to the Chief Commercial Officer and partner with Operations, Clinical Programs, Finance/FP&A, and Revenue Cycle Management • Interface with the CEO, Board of Directors, and national payer C-suites

🎯 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 • Demonstrated ability to translate payer strategy into revenue growth, margin improvement, and payer mix optimization • Experience designing or negotiating value-based arrangements: shared savings, bundled payments, quality incentives, outcomes-based contracts, or population health models • Familiarity with clinical quality metrics: HEDIS, NCQA, patient satisfaction, clinical outcomes, and cost-effectiveness • Strategic partnership development beyond traditional contracting: SDOH collaborations, pilot programs, innovation initiatives • 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 • Ability to lead cross-functionally across Operations, Clinical, Finance, and RCM without direct authority • MBA, MHA, JD, or equivalent advanced degree is preferred • Urgent care contracting experience, behavioral health contracting, pediatric healthcare, prior consulting experience, former health plan experience, CMS or state Medicaid experience, and telehealth reimbursement expertise are preferred