Executive VP, Payer Strategy & Market Access

PM Pediatrics; Northern (KY); Hybrid; USD 220,000 - 275,000; Full time

Job summary

PM Pediatric Care is scaling a national behavioral health platform, seeking an experienced VP & Head of Payer Strategy. You will own national payer relationships, drive contract strategy, rate negotiations, and multi-state expansion for Urgent Care and Behavioral Health.

This executive role reports to the Chief Commercial Officer and collaborates with Finance, Operations, and Clinical Leadership to translate quality and outcomes into payer value. Remote in the Northeast with national scope.

Qualifications

• 10+ years in healthcare payer strategy or contracting.
• 5+ years in senior leadership roles (VP, SVP, or Director-level).
• Proven executive relationships with major payers (e.g., UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, Humana).
• Direct experience negotiating multi-million dollar payer contracts with measurable results.
• Multi-state contracting experience including Medicaid, telehealth policies, and regional BCBS plans.
• Provider credentialing expertise: CAQH, payer enrollment, multi-state licensure.
• Financial modeling and market benchmarking for contract performance.
• Strong written, verbal, and presentation skills for executive reporting.

Responsibilities

• National Payer Strategy & Tier 1 Relationship Leadership (Urgent Care) - own strategic relationships with Tier 1 payers and serve as executive liaison.
• Negotiate rate renewals, expand coverage, and improve contract terms (facility fees, after-hours differentials, coding/billing).
• Lead escalation management for contract disputes and compliance challenges.
• Translate clinical quality and outcomes into payer value propositions.
• Lead behavioral health payer contracting and multi-state market entry.
• Design and execute payer entry playbooks and post-contract optimization.
• Develop value-based care partnerships and performance dashboards.

Job description

PM Pediatric Care is scaling a national behavioral health platform, seeking an experienced VP & Head of Payer Strategy. You will own national payer relationships, drive contract strategy, rate negotiations, and multi-state expansion for Urgent Care and Behavioral Health.

This executive role reports to the Chief Commercial Officer and collaborates with Finance, Operations, and Clinical Leadership to translate quality and outcomes into payer value. Remote in the Northeast with national scope.