Director, Payer Contracting
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Job Description
Payer contracting director negotiating Medicaid value-based agreements for Equality Health. Structuring risk arrangements, operationalizing contracts, and expanding payer partnerships across markets.
Responsibilities:
- Support and assist in designing innovative payer contract structures, including shared savings, downside risk, capitation, and bundled payment models
- Align contracting strategy with enterprise growth goals, clinical models, and financial targets
- Lead end-to-end negotiations with Medicaid managed care organizations and other payer partners
- Manage executive-level relationships with payer counterparts
- Position Equality Health as a preferred partner for value-based care delivery and population health management
- Partner with finance, actuarial, clinical, and operations teams to ensure contracts are financially sound and operationally executable
- Translate contract terms into performance expectations, KPIs, and reporting frameworks
- Monitor medical cost trends, quality metrics, and risk adjustment outcomes
- Lead renegotiations and contract optimizations based on performance insights
- Collaborate with network development, provider relations, and clinical teams to align incentives and ensure provider readiness for risk-based models
- Work with legal and compliance to structure contracts meeting regulatory requirements
- Partner with finance and analytics teams on pricing, forecasting, and performance measurement
- Support entry into new markets by establishing payer relationships and securing Medicaid plan contracts
- Identify opportunities to expand existing contracts to new populations, services, or geographies
- Provide stakeholder updates on pipeline, contract status, and financial impact
- Contribute to payer strategy and performance presentation materials
Requirements:
- Associate’s degree or higher and/or equivalent experience in a healthcare or related field of study
- 10+ years of experience in payer contracting, network management, or healthcare business development
- Deep expertise in Medicaid managed care and value-based payment models
- Proven track record negotiating and managing complex, risk-based contracts
- Strong understanding of healthcare economics, including medical cost drivers, risk adjustment, and quality incentives
- Experience working with or contracting on behalf of Medicaid managed care organizations, MSOs, ACOs, or risk-bearing provider groups
- Experience in multi-state Medicaid environments and familiarity with state-specific regulations
- Experience cross-functionally operationalizing contracts in provider or payer organizations
- Excellent negotiation, communication, and relationship management skills
- Preferred: strong, trusted relationships with key Medicaid health plans
- Preferred: background in a top-tier healthcare consulting firm such as McKinsey & Company, Bain & Company, or Boston Consulting Group
- Preferred: strong analytical and financial modeling capabilities
- Preferred: MBA, MHA, or related advanced degree
Benefits:
- Equal employment opportunities and nondiscrimination protections
- Exempt classification
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