CareAbout Health hiring Senior Vice President, Payer & Network Strategy in New York City Metropolitan Area | LinkedIn (2024)

Company Description

CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes.

Role Title: Senior Vice President, Payer & Network Strategy

FLSA Category: Exempt

Role Location: Hybrid

Reporting Relationships:

This position reports to the Chief Strategy Officer.

Role Summary and Responsibilities:

We are seeking a highly skilled and experienced Senior Vice President to lead our Payer Network Strategy team. This role will focus on improving fee-for-service rates and developing value-based arrangements within our payer network. The ideal candidate will possess strong leadership abilities, excellent communication skills, and a proven track record of optimizing performance across various markets. This role offers a unique opportunity to lead the transformation of our payer network strategy, driving improved reimbursem*nt rates and advancing our organization's mission of delivering high-quality, cost-effective care. If you are a strategic thinker with a passion for healthcare innovation, we invite you to apply for this exciting position.

Key Responsibilities / Essential Functions:

• Develop and implement strategies to improve fee-for-service rates within the payer network.
• Lead efforts to transition towards value-based payment arrangements, including bundled payments, pay-for-performance, and accountable care organizations.
• Collaborate with local leadership teams to understand market dynamics and tailor strategies accordingly.
• Analyze payer contracts and identify opportunities for optimization and negotiation.
• Provide guidance and support to the team in negotiating contracts and developing innovative payment models.
• Monitor and evaluate the performance of payer contracts, identifying areas for improvement and implementing corrective actions, as necessary.
• Stay abreast of industry trends and regulatory changes affecting payer reimbursem*nt and network strategy.
• Foster relationships with key stakeholders, including payers, providers, and regulatory bodies, to advance organizational objectives.
• Oversee healthcare provider network contracting efforts to support the management of medical expenses within our value-based arrangements.
• Collaborate with internal and external stakeholders to negotiate favorable terms and conditions with healthcare providers, ensuring alignment with organizational goals and objectives.
• Analyze provider performance data and network utilization patterns to identify opportunities for cost savings and efficiency improvements.
• Develop and implement strategies to optimize provider network performance, including network expansion, provider incentive programs, and performance improvement initiatives.
• Monitor provider contract compliance and performance metrics, implementing corrective actions as needed to ensure adherence to contractual agreements and quality standards.
• Stay abreast of emerging trends and best practices in healthcare provider contracting and reimbursem*nt, incorporating innovative approaches into network strategy development.

Non-Essential Functions

• Other duties, as assigned.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, or related field. Master's degree preferred.
• Minimum of 10 years of experience in payer contracting, network development, or related roles within the healthcare industry.
• Demonstrated expertise in fee-for-service and value-based payment models.
• Strong analytical skills with the ability to interpret complex data and make strategic recommendations.
• Excellent leadership and interpersonal skills, with the ability to collaborate effectively across departments and with external partners.
• Proven track record of driving results and achieving financial targets.
• Knowledge of healthcare regulatory requirements and reimbursem*nt methodologies.
• Ability to travel as needed to various markets to meet with local leadership and stakeholders.

Physical Requirements

• Mainly sedentary.
• Sitting at the desk most of the day.
• Standing or walking less than two hours per day.
• Lifting no more than ten pounds on rare occasions.
• Must be able to work at a computer and answer phone calls on a regular basis.

Compensation is based on the level and requirements of the role.

Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.

CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).

We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time.