Director, Payer Strategy and Contracting

Cayaba Care

7d•$150,000 - $170,000

About The Position

The United States has the poorest maternal and birth outcomes of all developed countries with underserved, Black, Brown, Indigenous communities disproportionately affected. Cayaba Care is working to drastically improve the experience of affected communities by reimagining how we deliver meaningful and compassionate care to expectant moms. Cayaba Care's mission is to improve pregnancy, birth and the postpartum journey for women and their families by reimagining how maternity care is delivered. Our team is focused on building trust-based engagement and wrap-around support for expectant moms at home, in person and virtually, to ensure they have all the social support they need for a successful and joyful pregnancy journey. We leverage technology to support our virtual engagement that allows us to meet all our moms where they are. We ensure that our members do not feel alone during their pregnancy journey, and that they have a trusted resource for support, resources, and information throughout their pregnancy, delivery and well into postpartum. Cayaba Care does not replace the primary obstetrician or doctor’s relationships. Instead, we support expectant mothers with all other support services that are traditionally not available through their doctors’ offices. Our Values: Empathy is at the heart of everything we do. We must always center the experiences of the mothers and families we serve, as well as support and uplift one another. Collaboration is what makes us stronger. We achieve the greatest impact when we work together, share knowledge, and elevate each other’s strengths. Resilience reflects our ability to push through challenges, adapt in a fast-changing environment, and remain committed to our mission no matter the obstacles. In this highly visible role, the Director of Payer Strategy and Contracting will drive new business growth and ensure ongoing success in our strategic health plan partnerships, while also deepening external payer relationships to identify new product opportunities and drive further alignment. This role is a highly collaborative role across Cayaba’s ELT and SLT teams. Reporting to and working closely with the Chief Executive Officer, the Director of Payer Strategy and Contracting is responsible for capturing new business opportunities and ensuring partner satisfaction within the healthcare payer sector. This role requires cross functional communication, process management, and collaboration with our Growth, Care Operations, Technology and Finance teams to strategically and successfully partner with Medicaid plans and healthcare systems.

Requirements

Bachelor’s Degree in business, communications, health administration or a related field required
MBA or equivalent
7+ years experience in healthcare payer strategy or consulting in payer contracting space
Deep understanding and experience with developing and negotiating payer contracts, particularly for Medicaid MCOs; commercial payer experience is a plus
Deep network and previously established relationships with Medicaid payers
Experience with successful value-based contracting options for specialty services with Medicaid or commercial payers
Excellent written and interpersonal communication skills including active listening, self-management and awareness, emotional intelligence, and a high degree of integrity and professionalism
Proven financial acumen and ability to identify the impact of changes on budget goals and financial targets
Experience facilitating buy-in and engagement across diverse stakeholder groups
Ability to anticipate risks and mitigate effectively
Proven experience selling to C-level executives nationally
Proven record of exceeding sales quota
Experience with Hubspot, Google Suite required
Experience with Series A - Series C start-ups
Ability to travel as needed (up to 30%) for meetings and conferences

Nice To Haves

Experience in women’s health, pediatrics and specialty populations a plus

Responsibilities

Plan, develop, direct, coordinate and monitor all activities to successfully bring our product and services to new payers
Navigate contract strategy, negotiations, and renegotiations to optimize partnership structure and success
Manage contract negotiations with current and future Medicaid and commercial payers
Own pricing model and reviewing of unit economics for each contract
Leverage data to generate insights and identify new opportunities for payer partnership growth
Collaborate with cross functional, internal stakeholders to deliver insights to inform product operations and strategy
Evaluate current and potential new geographic areas for new business opportunities
Oversee policy and regulatory environment and serve as an expert level resource related to business review of all contracts, amendments, and correspondence
Collaborate with the Finance and Product teams to develop alternative payment models and ensure delivery of engagement and outcome based performance
Identify opportunities for enhanced relationships, reimbursement, referrals, and a growing market presence
Prepare forecasts and advise the Executive Leadership Team (ELT) on all matters concerning net revenues in the areas of Medicaid and commercial partnerships
Drive sales to increase revenue growth with new (and renewed contracts) to expand Cayaba Care’s value-add to healthcare payer clients, and increase overall domain footprint
Identify and capture add-on, new capability, and cross-sell opportunities to drive sales and revenue growth within the healthcare payer industry
Work closely with the CEO to explore new sales opportunities and ensure a unified approach to payer partnership and contract management
Develop and recommend payer pricing, contracting and operational strategies to optimize the long-term financial profitability of the company
Work closely with the Finance team to evaluate, source, design, recommend, and monitor the execution and effectiveness of processes designed to ensure timely and accurate reimbursement from payers

Benefits

Time Off That Works for You
Recharge with annual paid holidays off.
Salaried (Exempt) Employees: Enjoy unlimited time off after the 90-day probation period.
Full-Time (Non-exempt) Employees: Receive three weeks of paid time off after the 90-day probation period.
Comprehensive Health & Wellness Coverage
Medical Insurance: Access top-tier healthcare, covering hospital, surgical, and prescription drug benefits. Coverage begins the first of the following month.
Dental Insurance: Coverage for preventive care, as well as basic and major procedures.
Vision Insurance: Coverage for routine eye exams and eyeglasses.
Security & Future Planning Options
Life Insurance: Financial protection for your beneficiaries.
Disability Insurance: Short-term and long-term coverage in case of illness or injury.
401(k) Retirement Plan: Opportunity to save for the future.