Director, Payer Strategy – Contracting

Role Overview

• Plan, develop, direct, coordinate and monitor all activities to successfully bring our product and services to new payers
• Navigate contract strategy, negotiations, and renegotiations to optimize partnership structure and success
• Manage contract negotiations with current and future Medicaid and commercial payers
• Own pricing model and reviewing of unit economics for each contract
• Leverage data to generate insights and identify new opportunities for payer partnership growth
• Collaborate with cross functional, internal stakeholders to deliver insights to inform product operations and strategy
• Evaluate current and potential new geographic areas for new business opportunities
• Oversee policy and regulatory environment and serve as an expert level resource related to business review of all contracts, amendments, and correspondence
• Collaborate with the Finance and Product teams to develop alternative payment models and ensure delivery of engagement and outcome based performance
• Identify opportunities for enhanced relationships, reimbursement, referrals, and a growing market presence
• Prepare forecasts and advise the Executive Leadership Team (ELT) on all matters concerning net revenues in the areas of Medicaid and commercial partnerships
• Drive sales to increase revenue growth with new (and renewed contracts) to expand Cayaba Care’s value-add to healthcare payer clients, and increase overall domain footprint
• Identify and capture add-on, new capability, and cross-sell opportunities to drive sales and revenue growth within the healthcare payer industry
• Work closely with the CEO to explore new sales opportunities and ensure a unified approach to payer partnership and contract management
• Develop and recommend payer pricing, contracting and operational strategies to optimize the long-term financial profitability of the company
• Work closely with the Finance team to evaluate, source, design, recommend, and monitor the execution and effectiveness of processes designed to ensure timely and accurate reimbursement from payers

Requirements

• Bachelor’s Degree in business, communications, health administration or a related field required
• MBA or equivalent
• 7+ years experience in healthcare payer strategy or consulting in payer contracting space
• Deep understanding and experience with developing and negotiating payer contracts, particularly for Medicaid MCOs; commercial payer experience is a plus
• Deep network and previously established relationships with Medicaid payers
• Experience with successful value-based contracting options for specialty services with Medicaid or commercial payers
• Excellent written and interpersonal communication skills including active listening, self-management and awareness, emotional intelligence, and a high degree of integrity and professionalism
• Proven financial acumen and ability to identify the impact of changes on budget goals and financial targets
• Experience facilitating buy-in and engagement across diverse stakeholder groups
• Ability to anticipate risks and mitigate effectively
• Proven experience selling to C-level executives nationally
• Proven record of exceeding sales quota
• Experience with Hubspot, Google Suite required
• Experience with Series A
• Series C start-ups
• Ability to travel as needed (up to 30%) for meetings and conferences
• Experience in women’s health, pediatrics and specialty populations a plus.

Benefits

• Recharge with annual paid holidays off.
• Salaried (Exempt) Employees: Enjoy unlimited time off after the 90-day probation period.
• Full-Time (Non-exempt) Employees: Receive three weeks of paid time off after the 90-day probation period.
• Medical Insurance: Access top-tier healthcare, covering hospital, surgical, and prescription drug benefits. Coverage begins the first of the following month.
• Dental Insurance: Coverage for preventive care, as well as basic and major procedures.
• Vision Insurance: Coverage for routine eye exams and eyeglasses.
• Life Insurance: Financial protection for your beneficiaries.
• Disability Insurance: Short-term and long-term coverage in case of illness or injury.
• 401(k) Retirement Plan: Opportunity to save for the future.