Director of Payor Strategy and Value

ACES•San Diego, CA

2d•$140,000 - $170,000•Onsite

About The Position

ACES is building a payor strategy that will define the next 3-5 years of growth. Our objective is to articulate our differentiated clinical and operational value, secure the right contracts at the right rates for each payer, expand value-based partnerships with national and regional health plans, and execute a scalable payer go-to-market strategy that supports long-term growth. ACES seeks a hungry, humble and collaborative leader who is equally comfortable developing strategy and rolling up their sleeves to execute it. This individual will translate vision into action by building strong payer relationships, driving complex negotiations, identifying innovative reimbursement opportunities, and partnering cross-functionally to deliver measurable results. Success in this role requires both strategic thinking and a scrappy, entrepreneurial mindset, with a relentless focus on creating long-term value for ACES, our payer partners, and the individuals we serve. The Director of Payor Strategy & Value will be responsible for co-architecting and executing on ACES’ enterprise payor strategy by leading national and state-level payor contracting, negotiations and relationships; advancing value-based and alternative payment models; translating payor contracts into scalable, compliant operational workflows; and partnering cross functionally with finance, operations, growth, and clinical leadership to drive the best client outcomes, client growth, market expansion and margin expansion.

Requirements

Direct experience negotiating and structuring alternative reimbursement models and value-based care agreements (shared savings, risk corridors, quality-based bonuses, case rate/bundled models)
Has built partnerships and problem solved with a growth mindset to drive growth (volume, rate)
Operated intersection of strategy and payor relations — i.e., informed enterprise strategy (market entry, M&A targets, service line expansion) and executed it through contracts
Translated strategy into cross-functional, detailed action
Obsession for win-win value creation and translating ACES’ vision and purpose into growth to ensure ACES and payor return on investment
Fluent in translating company needs and clinical model with payors and visa versa
Creative thinker, problem solver and dot connector to envision/capitalize on payor/employer solutions
Cross-functional collaborator; quickly builds trust and rapport
High learning agility with natural orientation to continuously improve results
Owner mentality who can make progress without significant support or direction
Bachelors or Master’s degree with 6-10 years experience in professional or multi-site healthcare business in strategic payor role strongly preferred
Alternative payment methodologies experience (e.g. pay for performance, value-based care) highly preferred with demonstrated track record/outcomes
3-5 years demonstrated leadership and cross-functional experience, preferably within a payor team
High level organizational skills, with strong attention to detail
Curiosity: Listening and learning mindset
Distinguished interpersonal, communication (oral, written) and problem-solving skills
Professional selling skills – able to translate value of ACES clinical product/model to a Payor partner
Metrics-Driven: Strong accountability, with proven success in meeting timelines and deliverables
Applied behavior analysis (ABA) experience and related licensure a plus

Responsibilities

Co-architect and implement strategically valuable and economically sustainable payor strategies: Contracting roadmap for commercial payors, Medicaid MCOs, regional centers, school districts
Advance value-based and alternative payment models (P4P, bundles, outcomes-based arrangements), translating clinical quality and access metrics into defensible economic value
Develop state-specific payor playbooks for priority and emerging markets with Field/Growth Ops
Execute on payor strategy action plans, including building cross functional action plans that maintain or strengthen relationships with key payors
Set and manage to geography-specific payor-mix goals
Manage payor negotiations end-to-end, including rate setting, contract structure, escalators, carve-outs and amendments
Drive conversations with stakeholders for regular rate review and negotiation, bringing in senior executives to support when needed/additive
Report-outs on performance, opportunities and risk to executive team and key stakeholders
Manage and create win-win payor relationships, serving as the primary interface, to position ACES as the best in ABA and a data-driven partner in early intervention and medically necessary ABA services
Ensure high-level engagement, leveraging ACES leaders to strategically enhance relationships
Represent and advocate for ACES “ABA product”
Identify and mitigate payor-related risk, including adverse policy changes, utilization management friction, denials and reimbursement erosion—proactively escalating and resolving issues
Partner with Data and Analytics team to forecast and evaluate the results of strategic options
Analyze trends for business opportunities and market clinical/business changes
Model rate changes and forecast payor mix impacts and profitability by payor; develop perspective on financial levers to pull through payor contracting, e.g. indirect hours impact, mid-tiers, overlaps, VBC, etc