Vice President, Payer Contracting

McLean, VA REMOTE

Overview

As the Vice President of Payer Contracting Strategy within the Business Development team, you will lead and execute the Company’s payer contracting strategy, including, but not limited to, Commercial, Medicare Advantage, and Medicaid plans, and oversee the development of new initiatives to enhance payer value and alignment for value-based care programs.

This role will report t o the SVP PE and BD.

This is a fully remote role within the US with preference to work Eastern Time Zone hours.

Responsibilities

Drive creative and alternative pricing and contract structures to ensure value to the payer and profitable for the company.

Lead the company’s payer contracting strategy, and actively pursue and drive the development and execution of profitable agreements across Medicare Advantage, commercial insurance, Medicaid and Medicare FFS (direct contracting).

Oversee the development of short and long term cross-payer contracting strategies, such as : broker services, health plan marketing, benefit design integration, high-value network offerings, health plan value-reporting and regional, multi-payer initiatives.

Maximize efficiency and standardization of the payer contracting and pricing process for the company by establishing internal contract valuation and reporting methodologies to assess current and future total contract value and relative risk by line of business.

Manage and drive, in collaboration with the company’s clinical, operations, and finance teams, overall value based care contracting with payers and other risk bearing entities.

Develop proforma models of contracts that show variability in revenue and EBIDTA by taking on different types of risk contracts from PMPM one end of the spectrum to full risk on the other end.

Lead and participate in contract negotiation discussions with health plan prospective customers

Develop renewal strategies for long-term arrangements. Determine the effectiveness of arrangements with long-term clients and recommend appropriate changes for updates to renewals.

Management

Execute and negotiate complex commercial agreements with health plans, evaluate contract economics, and develop creative growth strategies.

This includes determining performance goals and managing workflows, etc.

Thought Leadership & Reporting

Advise senior leadership and other enterprise-wide stakeholders on payer strategy, positioning, emerging trends, contracting methodologies and risk assessment and act as a strategic thought leader and partner for internal and external stakeholders

Qualifications

Required Education & Experience

A Master’s Degree in Health Care, Public Health or Business Administration is preferred.

10+ years related experience in a managed care payer environment, with a minimum of 5 years management or leadership experience in value-based care.

Preferred Knowledge, Skills, And / or Abilities

Prior experience as a thought leader and participation on industry panels

In-depth knowledge of the payer market including commercial, Medicare and Medicaid.

Strong, results-oriented leadership ability in a fast-paced, matrix organization.

Strong financial and operational acumen and understanding of profitability drivers and medical cost trends that drive gains and losses across risk pools.

Ability to recognize and execute on growth opportunities across payers and markets and adapt business development and contracting approaches, as needed.

Proven track record of creating, maintaining, and enhancing customer relationships and communicating effectively with senior management.

Passionate about driving the shift from fee-for-service to value-based care.

Track record of leading teams through white space strategic issues, developing frameworks that guide teams to solutions, and implementing those solutions.

Ability to think beyond your immediate team and contribute to making the organization holistically better (active engagement in DE&I efforts, culture initiatives, facilitating training, leading roundtables, etc.).

Physical Requirements

Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.

Ability to travel 25%-65%

We are flexible with respect to geographic location.as long as you are comfortable working remotely within the US with considerable amounts of travel.

The ideal candidate will be open to relocating to McLean, VA.

Other Duties

Please note, this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job.

Duties, responsibilities, and activities may change at any time with or without notice.