Cayaba Care

Director, Payer Strategy – Contracting

Cayaba Care

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $150,000 - $170,000 per year

Job Level

Lead

About the role

  • 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.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
payer contractingcontract negotiationspricing model developmentdata analysisfinancial acumenvalue-based contractingsales strategyforecastingbusiness reviewstakeholder engagement
Soft Skills
interpersonal communicationactive listeningself-managementemotional intelligenceintegrityprofessionalismrisk anticipationmitigationbuy-in facilitationengagement
Certifications
Bachelor’s DegreeMBA