Vice President – Head of Payer Strategy

Job not on LinkedIn

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $220k - $275k / year

⏰ Full Time

🔴 Lead

👔 Vice President

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PM Pediatric Care

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2005

🏥 Healthcare

⚕️ Healthcare Insurance

📚 Education

Healthcare • Healthcare Insurance • Education

PM Pediatric Care is a healthcare provider specializing in pediatric urgent care and comprehensive behavioral health services for children and young adults aged 5-26. The company offers convenient, top-quality, evidence-based medical care with services that include virtual visits, medication management, and psychiatric services. Additionally, PM Pediatric Care provides educational resources for parents and caregivers and works closely with schools to improve K-12 student outcomes with full-spectrum physical and mental health programs. They also have strategic partnerships with leading health systems and provide professional development for clinicians.

📋 Description

• Own strategic relationships with Tier 1 payers and serve as executive liaison to payer leadership • Negotiate multi-year rate renewals, geographic coverage, facility fees, after-hours differentials, and coding/billing policies • Resolve contract disputes, network adequacy issues, audit challenges, and compliance challenges • Translate clinical quality, patient satisfaction, and cost-effectiveness into payer value propositions • Analyze rate structures, benchmark against market, and identify rate improvement opportunities • 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 • Lead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs • Navigate 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 incentives, and outcomes-based contracts • Lead strategic payer pilots involving integrated care, SDOH collaborations, pediatric behavioral health integration, and alternative reimbursement models • Design clinical-financial frameworks and model upside/downside scenarios for value-based contracts • Position PM Pediatrics for emerging payment models and identify strategic payer partnership opportunities • Build payer performance dashboards and benchmark rates and contract terms • 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 • Drive $15M–$25M in cumulative revenue impact

🎯 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 • 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 • Familiarity with HEDIS, NCQA, patient satisfaction, clinical outcomes, and cost-effectiveness • Strategic partnership development beyond traditional contracting • Executive presence and 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 • Preferred: urgent care contracting, behavioral health contracting, pediatric healthcare, MBA/MHA/JD or equivalent advanced degree, top-tier healthcare strategy consulting, former health plan experience, CMS or state Medicaid experience, and telehealth reimbursement expertise