It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
**This is a remote position, but must reside in the Northeast**
PM Pediatric Care is scaling a behavioral health platform to address the mental health crisis facing children and adolescents. We operate state-based clinical pods across New York, New Jersey, and Florida, with national expansion underway. Over the next 24 months, we are growing from 75K to 150K+ annual visits and $15M to $50M+ in revenue.
The VP & Head of Payer Strategy is the enterprise payer strategist and chief negotiator for PM Pediatric Care's Urgent Care and Behavioral Health service lines. This role owns national payer relationships, contract strategy, rate negotiations, multi-state expansion, and value-based partnership development. You will serve as the executive voice to Tier 1 payers, BCBS plans, Medicaid programs, and value-based care organizations.
You will operate at the intersection of clinical strategy, financial performance, and market access, translating clinical quality and patient outcomes into payer value propositions, negotiating contracts that balance network inclusion with financial sustainability, and building partnerships that position PM Pediatrics for long-term advantage.
Reports to: Chief Commercial Officer. Partners closely with: SVP Operations (Urgent Care and Behavioral Health), VP Clinical Programs, Finance/FP&A, and Revenue Cycle Management.
This is a high-visibility executive role with direct exposure to the CEO, Board of Directors, and national payer C-suites.
National Payer Strategy & Tier 1 Relationship Leadership (Urgent Care) — 40%
Own strategic relationships with Tier 1 payers: UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, and Humana; serve as executive liaison to payer leadership at the C-suite and senior VP levels
Negotiate multi-year rate renewals, expand geographic coverage, and improve contract terms including facility fees, after-hours differentials, and coding/billing policies
Behavioral Health Contract Expansion & Multi-State Market Entry — 35%
Accelerate behavioral health payer contracting in NY, NJ, and FL, and lead payer entry into 6+ new states over 24 months
Negotiate rates, terms, and coverage policies that support financial sustainability, with a target of $200K–$280K revenue per clinical FTE
Navigate state-specific contracting landscapes including Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies
Design and execute a behavioral health payer entry playbook covering market landscaping, contract negotiation sequencing, credentialing project management, and post-contract optimization
Value-Based Care & Strategic Partnership Development — 20%
Evaluate and build value-based care partnerships: shared savings, bundled payments, quality incentive programs, and outcomes-based contracts
Lead strategic payer pilots including integrated care models, SDOH collaborations, pediatric behavioral health integration, and alternative reimbursement models
Design clinical-financial frameworks for value-based arrangements, including quality metrics, financial risk models, and performance monitoring
Identify strategic payer partnership opportunities beyond traditional contracting, including data sharing, care coordination platforms, and referral network integrations
Payer Analytics, Performance & Cross-Functional Leadership — 5%
Build payer performance dashboards tracking contract utilization, revenue per contract, payer mix, claims denial rates, and financial performance by payer
Build and lead the payer strategy team as the organization scales, including future hires in payer contracting, credentialing, and analytics
Target Compensation: $220,000 - $275,000
The salary/rate range listed here has been provided to comply with local regulations and represents a potential base salary/rate for this role. Please note that actual salaries/rates may vary within this range above or below, depending on experience and location. We look at compensation for each individual and based on experience and qualifications.
Payer Strategy & Contracting
5+ years in senior leadership roles (VP, SVP, or Director-level) with direct accountability for payer negotiations, contract performance, or network strategy
Proven track record of building and leveraging executive-level relationships with UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, Humana, or equivalent Tier 1 payers
Multi-Site & Multi-State Healthcare
Experience in multi-site healthcare settings: urgent care, behavioral health, outpatient specialty, or retail healthcare
Financial & Analytical Skills
Strong financial modeling: contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment
Value-Based Care & Strategic Partnerships
Experience designing or negotiating value-based arrangements: shared savings, bundled payments, quality incentives, outcomes-based contracts, or population health models
Familiarity with clinical quality metrics: HEDIS, NCQA, patient satisfaction, clinical outcomes, and cost-effectiveness
Leadership & Communication
Ability to lead cross-functionally across Operations, Clinical, Finance, and RCM without direct authority
Additional Qualifications
MBA, MHA, JD, or equivalent advanced degree in business, healthcare administration, or law
Prior consulting experience at top-tier healthcare strategy firms (McKinsey, Bain, BCG, Accenture, Navigant/Guidehouse)
Former health plan experience at UnitedHealthcare, Aetna, Cigna, Anthem, Humana, or a regional health plan in network strategy, provider relations, or medical management
Compensation:
Role Dependent
The salary/rate range listed here has been provided to comply with local regulations and represents a potential base salary/rate for this role. Please note that actual salaries/rates may vary within this range above or below, depending on experience and location. We look at compensation for each individual and based on experience and qualifications.
PM Pediatric Care is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status or any other characteristic protected by law.
