PM Pediatric Care

Specializes in pediatric urgent care services

Vice President and Head of Payer Strategy

Business OperationsConfirmed live in the last 24 hours

Full-timeRemote in USA$220k - $275k

About the Job

Requirements

At least 10 years of experience in healthcare payer strategy, network contracting, or health plan partnerships with progressive responsibility.
At least 5 years in senior leadership roles with direct accountability for payer negotiations, contract performance, or network strategy.
A proven record of building and leveraging executive-level relationships with UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, Humana, or equivalent Tier 1 payers.
Direct experience negotiating multi-million-dollar payer contracts with measurable results, such as rate improvements, contract wins, or revenue growth.
Experience in multi-site healthcare settings such as urgent care, behavioral health, outpatient specialty, or retail healthcare.
Multi-state contracting experience, including Medicaid managed care, telehealth reimbursement policies, and regional BCBS plans.
Provider credentialing expertise, including CAQH, payer enrollment processes, and multi-state licensure requirements.
Strong financial modeling skills, including contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment.
Comfort with payer analytics, claims data, utilization reports, and contract performance dashboards.
P&L orientation and demonstrated ability to translate payer strategy into revenue growth, margin improvement, and payer mix optimization.
Experience designing or negotiating value-based arrangements, such as shared savings, bundled payments, quality incentives, outcomes-based contracts, or population health models.
Familiarity with clinical quality metrics, including HEDIS, NCQA, patient satisfaction, clinical outcomes, and cost-effectiveness.
Experience in strategic partnership development beyond traditional contracting, including SDOH collaborations, pilot programs, and innovation initiatives.
Ability to build credibility with payer C-suites, internal executives, and board members.
Proven negotiation skills in complex, multi-party situations.
Strong written, verbal, and presentation skills for executive reporting and board-level updates.
Ability to lead cross-functionally across Operations, Clinical, Finance, and RCM without direct authority.

Responsibilities

Own strategic relationships with Tier 1 payers, including UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, and Humana, and 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 and billing policies.
Lead escalation management by resolving contract disputes, addressing network adequacy issues, and navigating audit and compliance challenges.
Translate clinical quality, patient satisfaction, and cost-effectiveness into compelling payer value propositions.
Analyze rate structures, benchmark against the market, and identify opportunities for rate improvement.
Align contract strategy with operational footprint, utilization patterns, and market expansion plans in partnership with SVP Urgent Care Operations.
Accelerate behavioral health payer contracting in New York, New Jersey, and Florida, and lead payer entry into six or more new states over 24 months.
Negotiate rates, terms, and coverage policies that support financial sustainability, with a target of $200,000–$280,000 revenue per clinical FTE.
Lead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric nurse practitioners across multiple states, and drive credentialing cycle time to under 45 days.
Navigate state-specific contracting landscapes, including Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies.
Leverage urgent care relationships to unlock behavioral health contracting opportunities using an integrated care value proposition.
Design and execute a behavioral health payer entry playbook covering market landscaping, contract negotiation sequencing, credentialing project management, and post-contract optimization.
Evaluate and build value-based care partnerships, including 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.
Model upside and downside scenarios for value-based contracts in partnership with Finance and Clinical Leadership.
Position the organization for emerging payment models, including CMS Innovation Center initiatives, Medicaid value-based purchasing, and payer-provider SDOH collaborations.
Identify strategic payer partnership opportunities beyond traditional contracting, including data sharing, care coordination platforms, and referral network integrations.
Build payer performance dashboards tracking contract utilization, revenue per contract, payer mix, claims denial rates, and financial performance by payer.
Benchmark rates and contract terms against urgent care and behavioral health competitors.
Lead cross-functional payer governance in partnership with RCM, Finance, and Operations.
Develop negotiation playbooks, contract templates, and rate benchmarking tools to scale the payer strategy function.
Build and lead the payer strategy team as the organization scales, including future hires in payer contracting, credentialing, and analytics.
Drive $15 million–$25 million in cumulative revenue impact through contract optimization, new payer partnerships, and value-based upside.

Desired Qualifications

Prior experience in a hospital system or urgent care environment.
Urgent care contracting experience, including reimbursement models, facility fees, and coding and billing policies.
Behavioral health contracting experience, including therapist and psychiatrist reimbursement, telehealth policies, and outcomes-based contracting.
Pediatric healthcare experience, including pediatric care models, family-centered care, and pediatric quality metrics.
MBA, MHA, JD, or equivalent advanced degree in business, healthcare administration, or law.
Prior consulting experience at top-tier healthcare strategy firms such as McKinsey, Bain, BCG, Accenture, or 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.
CMS or state Medicaid experience, including Medicare Advantage, Medicaid managed care, or public payer programs.
Telehealth reimbursement expertise, including interstate contracting, evolving telehealth policies, and virtual care reimbursement.

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.

Summary

**This is a remote position, but must reside in the Northeast**
**Prior experience in a hospital system or urgent care environment is strongly preferred**

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.

Description

Responsibilities

National Payer Strategy & Tier 1 Relationship Leadership (UrgentCare) —40%

Own strategic relationships with Tier 1payers: 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

Lead escalation management:resolvecontract disputes,addressnetwork adequacy issues, andnavigateaudit and compliance challenges

Translate clinical quality, patient satisfaction, and cost-effectiveness into compelling payer value propositions

Analyze rate structures, benchmark against market, andidentifyopportunities for rate improvement

Align contract strategy with operational footprint,utilizationpatterns, and market expansion plans in partnership with SVP Urgent Care Operations

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 over24 months

Negotiate rates, terms, and coverage policies that support financial sustainability, with a target of $200K–$280K revenue per clinical FTE

Lead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs across multiple states; drive credentialing cycle time to under45 days

Navigate state-specific contracting landscapes including Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies

Leverage urgent care relationships to unlock behavioral health contracting opportunities using an integrated care value proposition

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

Model upside/downside scenarios for value-based contracts in partnership with Finance and Clinical Leadership

Position PM Pediatrics for emerging payment models: CMS Innovation Center initiatives, Medicaid value-based purchasing, and payer-provider SDOH collaborations

Identifystrategic 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 contractutilization, revenue per contract, payer mix, claims denial rates, and financial performance by payer

Benchmark PM Pediatrics rates and contract terms against urgent care and behavioral health competitors

Lead cross-functional payer governance in partnership with RCM, Finance, and Operations

Develop negotiation playbooks, contract templates, and rate benchmarking tools to scale the payer strategy function

Build and lead the payer strategy team as the organization scales, including future hires in payer contracting, credentialing, and analytics

Drive $15M–$25M in cumulative revenue impact through contract optimization, new payer partnerships, and value-based upside

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.

Qualifications

Qualifications

Required

Payer Strategy & Contracting

10+ years in healthcare payer strategy, network contracting, or health plan partnerships with progressive responsibility

5+ years in senior leadership roles (VP, SVP, or Director-level) with direct accountability for payer negotiations, contract performance, or network strategy

Proventrack recordof building andleveragingexecutive-level relationships with UnitedHealthcare, Aetna, Cigna, Anthem/BCBS, Humana, or equivalent Tier 1 payers

Direct experience negotiating multi-million dollarpayer contracts with measurable results: rate improvements, contract wins, revenue growth

Multi-Site & Multi-State Healthcare

Experience in multi-site healthcare settings: urgent care, behavioral health, outpatient specialty, or retail healthcare

Multi-state contracting experience including Medicaid managed care, telehealth reimbursement policies, and regional BCBS plans

Provider credentialingexpertise: CAQH, payer enrollment processes, and multi-state licensure requirements

Financial & Analytical Skills

Strong financial modeling: contract rate analysis, market benchmarking, revenue impact modeling, and value-based care financial risk assessment

Comfort with payer analytics, claims data,utilizationreports, and contract performance dashboards

P&L orientation:demonstratedability to translate payer strategy into revenue growth, margin improvement, and payer mix optimization

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

Strategic partnership development beyond traditional contracting: SDOH collaborations, pilot programs, innovation initiatives

Leadership & Communication

Executive presence: ability to build credibility with payer C-suites, internal executives, and board members

Proven negotiation skills in complex, multi-party situations

Strong written, verbal, and presentation skills for executive reporting and board-level updates

Ability to lead cross-functionally across Operations, Clinical, Finance, and RCM without direct authority

Preferred

Industry Background

Urgent care contracting experience: reimbursement models, facility fees, coding/billing policies

Behavioral health contracting: therapist/psychiatrist reimbursement, telehealth policies, outcomes-based contracting

Pediatric healthcare: pediatric care models, family-centered care, pediatric quality metrics

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

CMS or state Medicaid experience: Medicare Advantage, Medicaid managed care, or public payer programs

Telehealth reimbursementexpertise: interstate contracting, evolving telehealth policies, and virtual care reimbursement

Compensation:

Role Dependent

EEO Statement

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.

About the Company

PM Pediatric Care

Specializes in pediatric urgent care services

PM Pediatric Care runs a network of pediatric urgent care clinics that operate year-round with extended hours to treat non-emergency pediatric illnesses and injuries outside regular pediatrician offices. Centers function like emergency departments with on-site digital X-ray and lab services, and they offer telemedicine, pediatric behavioral health, and school-based health programs. They focus exclusively on children—using pediatric specialists and child-specific equipment—to treat issues ranging from fractures to asthma, aiming to reduce unnecessary ER visits. Their goal is to provide accessible, high-quality acute pediatric care and related services across a growing network, expanding after-hours access and coordinating with primary care and hospitals.

Company size: 1,001-5,000
Company stage: Series E
Total funding: $72.4M
Headquarters: Town of North Hempstead, New York
Founded: 2005

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