Vice President, Payer Contracting

Equality Health; USA; Vor Ort; USD 180.000 - 290.000; Vollzeit

Zusammenfassung

Equality Health seeks a VP of Payer Contracting to lead strategy, negotiation, and execution of Medicaid value-based agreements across markets. You will structure complex risk-based contracts and partner with legal, finance, and provider groups to ensure performance and value.

The role requires deep Medicaid expertise, strong leadership, and the ability to align contracts with population health goals and enterprise growth.

Qualifikationen

• 10–15+ years in payer contracting, network management, or healthcare business development.
• Deep expertise in Medicaid managed care and value-based payment models.
• Proven track record negotiating and managing complex, risk-based contracts.
• Strong understanding of healthcare economics, including cost drivers and risk adjustment.
• Experience with Medicaid plans, MSOs, ACOs, or risk-bearing provider groups.
• Experience in multi-state Medicaid environments and regulatory familiarity.
• Cross-functional collaboration to operationalize contracts.

Aufgaben

• Develop and mature payer contracting strategy focused on Medicaid value-based arrangements.
• Lead end-to-end negotiations with Medicaid plans and payer partners.
• Ensure contracts are financially sound and operationally executable.
• Translate terms into KPIs and reporting frameworks.
• Monitor performance, cost trends, quality incentives, and risk adjustment outcomes.
• Collaborate with legal, compliance, finance, and analytics.

Kenntnisse

Payer contracting

Negotiation

Contract management

Healthcare economics

Cross-functional collaboration

Ausbildung

MBA or equivalent

MHA preferred

Jobbeschreibung

Reports To

Chief Strategy Officer & Interim Growth Officer

About The Organization

Equality Health is an integrated, holistic, and tech-enabled healthcare delivery system focused on improving the health and wellness of diverse populations. Founded in 2015, Equality Health aims to improve access to value-based care for people who have long struggled with navigating the traditional one-size-fits-all U.S. healthcare system. The mission of the company is to provide high-quality care that improves and enhances lives regardless of race, ethnicity, age, or income.

Position Title

Vice President, Payer Contracting

Reports To

Chief Strategy Officer & Interim Growth Officer

About The Organization

Equality Health is an integrated, holistic, and tech-enabled healthcare delivery system focused on improving the health and wellness of diverse populations. Founded in 2015, Equality Health aims to improve access to value-based care for people who have long struggled with navigating the traditional one-size-fits-all U.S. healthcare system. The mission of the company is to provide high-quality care that improves and enhances lives regardless of race, ethnicity, age, or income.

Business Model

Equality Health Operates a Dynamic Value-based Care Platform That Transforms The Current State Of Healthcare By Aligning, Engaging, And Empowering Providers And Health Plans To Focus Their Work On Individuals And Communities That Need It The Most. The Company's Core Value Proposition Includes

• Practice Transformation and Performance Support: Equality Health provides tools, high-touch practice and member support, and value-based incentives to primary care providers.
• Proprietary Technology: The platform is backed by actuarial intelligence and timely analytics and supports panel management, effective chart preparation, and connection to additional resources such as social determinants of health, behavioral health, and care management.
• Timely Value-Based Incentives: Providers receive quarterly payments based on activity, supporting preventive care, transitions of care, and high-risk member management.
• Multidisciplinary Care Team: The care model includes digital member engagement, telephonic care navigation, field-based teams, community health workers, chaplains, and nurse practitioners.

Equality Health partners with managed care organizations (MCOs) to support state-led initiatives and holds participation agreements with providers to support their attributed Medicaid members. The company's footprint spans multiple states, including Arizona, Texas, Louisiana, Virginia, and Tennessee, with a large and growing network of affiliated primary care providers.

Ownership Structure

Equality Health is a privately held company backed by private equity investors. Key investors include General Atlantic, Finback Investment Partners, Town Hall Ventures, and Endeavour. The company operates with a focus on population health risk management, improving care delivery outcomes for traditionally underserved populations in value-based care. Equality Health's comprehensive model bundles care coordination technology, practice transformation services, and provider incentives, enabling doctors to deliver effective and value-based primary care.

About The Role

Equality Health is seeking a dynamic and results-oriented Vice President of Payer Contracting to lead the strategy, negotiation, and execution of value-based agreements with Medicaid managed care organizations (MCOs). This leader will play a critical role in expanding and optimizing payer partnerships that support high-quality, cost-effective care for underserved populations.

The VP will operate at both the strategic and tactical levels—structuring complex risk arrangements while ensuring contracts are operationalized effectively across markets. This role requires deep expertise in Medicaid reimbursement, value-based care models, and payer-provider dynamics.

Key Responsibilities

Payer Contracting Strategy

• Develop and mature the organization’s payer contracting strategy, with a focus on Medicaid value-based arrangements.
• Design innovative contract structures, including shared savings, downside risk, capitation, and bundled payment models.
• Align contracting strategy with enterprise growth goals, clinical models, and financial targets.

Negotiation & Relationship Management

• Lead end-to-end negotiations with Medicaid managed care organizations and other payer partners.
• Own and manage executive-level relationships with payer counterparts.
• Position Equality Health as a preferred partner for value-based care delivery and population health management.

Contract Execution & Performance

• Partner with finance, actuarial, clinical, and operations teams to ensure contracts are financially sound and operationally executable.
• Translate contract terms into clear performance expectations, KPIs, and reporting frameworks.
• Monitor contract performance, including medical cost trends, quality metrics, and risk adjustment outcomes.
• Lead renegotiations and optimizations based on performance insights.

Cross-Functional Alignment

• Collaborate with network development, provider relations, and clinical teams to align incentives and ensure provider readiness for risk-based models.
• Work closely with legal and compliance to structure contracts that meet regulatory requirements.
• Partner with finance and analytic teams to support pricing, forecasting, and performance measurement.

Market Expansion & Growth

• Support entry into new markets by establishing payer relationships and securing contracts with Medicaid plans.
• Evaluate RFP opportunities and lead payer-related components of proposal development.
• Identify opportunities to expand scope of existing contracts (e.g., new populations, services, or geographies).

Governance & Reporting

• Participate in Contract Review Committee and lead where necessary, applying appropriate contracting governance processes, including approval frameworks and performance reviews.
• Provide regular updates to executive leadership on pipeline, contract status, and financial impact
• Contribute to board-level materials related to payer strategy and performance

Qualifications

Required

• 10–15+ years of experience in payer contracting, network management, or healthcare business development
• Deep expertise in Medicaid managed care and value-based payment models
• Proven track record of negotiating and managing complex, risk-based contracts
• Strong understanding of healthcare economics, including medical cost drivers, risk adjustment, and quality incentives
• Experience working with or contracting on behalf of Medicaid managed care organizations, MSOs, ACOs, or risk-bearing provider groups
• Experience in multi-state Medicaid environments and familiarity with state-specific regulations
• Experience working cross-functionally to operationalize contracts in provider or payer organizations
• Excellent negotiation, communication, and relationship management skills

Preferred

• Strong, trusted relationships with key Medicaid health plans
• Background in top-tier consulting firms such as McKinsey & Company, Bain & Company, or Boston Consulting Group, with healthcare focus
• Strong analytical and financial modelling capabilities
• MBA, MHA, or related advanced degree

Equality Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.