Director, Payer Partnerships – Job Description

Employment Type: Full Time
Level: Director
Location: Remote , USA

Who we are:

At Herself Health, we're on a mission to help women get more life out of life, together. We are building a new model of primary care for women 65+ to solve long-standing problems: rushed appointments, long wait times, and care that's generalized rather than specialized towards women’s needs later in life such as post-menopausal care, bone density, weight management, and mental, social and emotional well-being.

Our patient-centric Primary Care clinics are dispersed across Minneapolis/St. Paul, MN. We are thrilled to serve the Twin Cities metro in our clinics located in Highland Park (St. Paul), Crystal, and South Minneapolis with new clinics launching soon in both Rosedale and Eagan. Our team of 100+ colleagues is on a mission to innovate the primary care landscape for women 65+. We’re seeking like-minded individuals who share in this passion to join us!

About you:

As we grow our early team, we are seeking strategic thought leaders who have a passion for building and innovating. We foster a culture of collaboration, excellence and the willingness to roll up our sleeves and learn as we grow. We have a customer first mindset, and we are looking for team members who share that. Our ideal candidates have strategic prowess and the ability to use data to build best practices and implement great ideas in collaboration with our team and our community.

About the Director, Payer Partnerships Role:

The Director, Payer Partnerships plays a crucial role in forging and maintaining relationships with healthcare payers while strategically navigating the landscape of value-based care. This position requires a deep understanding of healthcare reimbursement models, payer dynamics, and value-based care initiatives. The individual will collaborate with internal stakeholders to develop and execute strategies that optimize reimbursement, improve patient outcomes, and drive organizational growth in alignment with value-based care principles.

Essential Functions:

1. Payer Relationship Management:

• Own, cultivate and maintain strong relationships with healthcare payers, including insurance companies, government payers, and accountable care organizations (ACOs).
• Serve as the primary point of contact for contract negotiations, collaboration between internal and external team members (marketing, operations, etc.) contract renewals, and issue resolution.
• Bring solutions to optimize performance in contracts across key contract levers e.g. shared risk, carveouts, attribution, quality cut points, etc.
• Collaborate with cross-functional teams to ensure alignment between payer contracts and organizational objectives and own joint operating committee meetings.

2. Primary Care Provider Attribution Strategy Execution:

• Develop the strategy and drive execution to increase attributed membership with payers
• Collaborate with payer partners on identifying unengaged members in the community for outreach
• Develop the strategy and drive execution to educate patients on Medicare Advantage during Annual Enrollment Period

2. Value-Based Care Strategy Development:

• Develop and implement strategic plans to transition from fee-for-service to value-based care reimbursement models.
• Stay abreast of industry trends, regulatory changes, and emerging best practices related to value-based care.
• Identify opportunities for innovation and improvement within value-based care programs.

3. Performance Monitoring and Analysis:

• Monitor key performance indicators (KPIs) related to value-based care contracts, such as quality metrics, cost savings, and patient satisfaction scores.
• Conduct data analysis to assess the impact of value-based care initiatives on financial performance and clinical outcomes.
• Generate insights and recommendations, and lead efforts internally, for optimizing contract performance and achieving total cost of care/shared savings targets.

4. Collaborative Partnerships:

• Collaborate with internal stakeholders, including clinical leadership, finance, operations, and growth, to drive alignment and support the success of value-based care initiatives. payer contracts
• Facilitate communication and collaboration between the organization and external partners, including providers, vendors, and community organizations involved in care delivery.
• Work closely with the Finance team to facilitate input and feedback on contracting discussions terms cross-functionally from growth and operations teams, and ensure terms align with capabilities to deliver.

5. Regulatory Compliance and Risk Management:

• Ensure compliance with regulatory requirements and contractual obligations related to value-based care arrangements (e.g. accreditation, delegation)
• Identify and mitigate risks associated with value-based care contracts, including financial, operational, and reputational risks.
• Provide guidance and support to internal teams on compliance-related matters.

Must-have Qualifications and Skills:

• Authorized to work in the United States
• Bachelors Degree
• Some travel, 25% depending on location
• Minimum of 8 years of experience in healthcare payer relations, strategy development, or value-based care management.
• Strong understanding of healthcare reimbursement models, including fee-for-service, bundled payments, shared savings, and capitation.
• Excellent communication, negotiation, and interpersonal skills.
• Proven ability to develop and execute strategic plans and drive organizational change.
• Proficiency in data analysis and experience with healthcare analytics tools.
• Knowledge of healthcare regulations, including Medicare and commercial payer requirements.
• Ability to work effectively in a fast-paced, dynamic environment and manage multiple priorities simultaneously.

We support Equal Employment Opportunities (EEO). We are committed to an inclusive workplace. We do not discriminate on the basis of race, religion, color, national origin, gender identity or expression, age, marital status, veteran status, disability status, parental status, political affiliation, or any other status protected by federal, state, or local laws.