Corporate

Corporate

Vice President & Head of Payer Strategy

Remote - United States · Exec

Sponsorship not specified$75k-$150kDetected 30 days ago
Project ManagementNegotiationFinancial ModelingFP&ALeadershipCommunication

About the role

  • It's fun to work in a company where people truly BELIEVE in what they're doing!
  • We're committed to bringing passion and customer focus to the business.
  • We operate state-based clinical pods across New York, New Jersey, and Florida, with national expansion underway.

Responsibilities

  • Own strategic relationships with Tier 1 payers: UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, and Humana; serve as executive liaison to payer leadership at the C-suite and senior VP levels
  • Lead escalation management: resolve contract disputes, address network adequacy issues, and navigate audit and compliance challenges
  • Lead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs across multiple states; drive credentialing cycle time to under 45 days
  • Evaluate and build value-based care partnerships: shared savings, bundled payments, quality incentive programs, and outcomes-based contracts
  • Design clinical-financial frameworks for value-based arrangements, including quality metrics, financial risk models, and performance monitoring
  • Build payer performance dashboards tracking contract utilization, revenue per contract, payer mix, claims denial rates, and financial performance by payer
  • Lead cross-functional payer governance in partnership with RCM, Finance, and Operations
  • Develop negotiation playbooks, contract templates, and rate benchmarking tools to scale the payer strategy function
  • Build and lead the payer strategy team as the organization scales, including future hires in payer contracting, credentialing, and analytics
  • Drive $15M-$25M in cumulative revenue impact through contract optimization, new payer partnerships, and value-based upside

Requirements

  • 5+ years in senior leadership roles (VP, SVP, or Director-level) with direct accountability for payer negotiations, contract performance, or network strategy
  • Provider credentialing expertise: CAQH, payer enrollment processes, and multi-state licensure requirements
  • Comfort with payer analytics, claims data, utilization reports, and contract performance dashboards
  • P&L orientation: demonstrated ability to translate payer strategy into revenue growth, margin improvement, and payer mix optimization
  • Familiarity with clinical quality metrics: HEDIS, NCQA, patient satisfaction, clinical outcomes, and cost-effectiveness
  • demonstrated ability to translate payer strategy into revenue growth, margin improvement, and payer mix optimization
  • Qualifications
  • Required
  • Payer Strategy & Contracting
  • 10+ years in healthcare payer strategy, network contracting, or health plan partnerships with progressive responsibility
  • 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
  • Multi-Site & Multi-State Healthcare
  • 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
  • Strong financial modeling: contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment

Nice to have

  • CMS or state Medicaid experience: Medicare Advantage, Medicaid managed care, or public payer programs
  • We look at compensation for each individual and based on experience and qualifications.
  • PM Pediatric Care is an equal employment opportunity employer.
  • Proven negotiation skills in complex, multi-party situations
  • Strong written, verbal, and presentation skills for executive reporting and board-level updates

Skills

  • CAQH, payer enrollment processes, and multi-state licensure requirements
  • Financial & Analytical Skills

Compensation

  • The salary/rate range listed here has been provided to comply with local regulations and represents a potential base salary/rate for this role.
  • We look at compensation for each individual and based on experience and qualifications.
  • $220,000 - $275,000
  • Over the next 24 months, we are growing from 75K to 150K+ annual visits and $15M to $50M+ in revenue.

Benefits

  • PM Pediatric Care is scaling a behavioral health platform to address the mental health crisis facing children and adolescents.
  • The VP & Head of Payer Strategy is the enterprise payer strategist and chief negotiator for PM Pediatric Care's Urgent Care and Behavioral Health service lines.
  • SVP Operations (Urgent Care and Behavioral Health), VP Clinical Programs, Finance/FP&A, and Revenue Cycle Management.
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