Director, Payer Contracting

Q Point Health LLC• US,

6h•Remote

About The Position

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

Requirements

Associate’s degree or higher and/or equivalent experience in a healthcare or related field of study
10+ 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

Nice To Haves

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 modeling capabilities
MBA, MHA, or related advanced degree

Responsibilities

Support and assist designing 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.
Lead end-to-end negotiations with Medicaid managed care organizations and other payer partners.
Manage executive-level relationships with payer counterparts.
Position Equality Health as a preferred partner for value-based care delivery and population health management.
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.
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.
Support entry into new markets by establishing payer relationships and securing contracts with Medicaid plans.
Help identify opportunities to expand scope of existing contracts (e.g., new populations, services, or geographies).
Provide regular updates to relevant stakeholders on pipeline, contract status, and financial impact.
Contribute to presentation materials related to payer strategy and performance.