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Vice President, Payer Contracting

Somatus

McLean, VA, US / Remote
  • Job Type: Full-Time
  • Function: Accounting/Finance
  • Industry: HealthCare Services
  • Post Date: 04/03/2024
  • Website: somatus.com
  • Company Address: 1861 International Dr, McLean, Virginia 22102, US
  • Salary Range: $50,000 - $150,000

About Somatus

Somatus partners with leading health plans, health systems, nephrology and primary care groups to provide integrated care for patients with or at risk of developing kidney disease. As the market leader in value-based kidney care, Somatus’ vertically integrated clinical services and technology delay or prevent disease progression, decrease avoidable hospital utilization, improve quality and care coordination, and increase the use of home dialysis modalities and rates of kidney transplantation.

Job Description

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 to 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 Somatus 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.
 
Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law.
 
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.

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