Head of Payer Network

VAXCARE LLC• US,

7h•Remote

About The Position

The Head of National Payer Network & Value-Based Care Strategy is VaxCare’s senior executive responsible for enterprise payer strategy, national contracting, reimbursement optimization, network strategy, and value-based care partnerships. The role is remote-based and initially reports to Founder and Chief Executive Officer Casey DeLoach. The posting anticipates that the position will report to the President or Chief Revenue Officer after those roles are hired as the commercial organization scales. The executive will develop strategies and partnerships that expand patient access and provider participation, improve reimbursement performance, and position VaxCare as a preferred partner for payers pursuing improved vaccination, preventive care, and physician-administered therapy outcomes. The remit spans Commercial, Medicare Advantage, Medicaid, PBMs, IPAs, CINs, ACOs, and employer-sponsored health plans. It includes managing and developing VaxCare’s existing payer contracts, negotiating national and regional agreements, building scalable contracting frameworks, and leading value-based programs and innovative reimbursement models. The role will work across payer operations, revenue cycle management, sales and growth, finance, and physician sales. It will lead payer relationships and market expansion, including California market expansion, and use claims, quality, reimbursement, and operational data to guide negotiations and quantify value. The executive may build a small dedicated team by assessing current staffing and identifying needed roles and capabilities. The posting states that the ideal candidate is located on the East Coast and is willing to travel 50–75% of the time.

Requirements

Seasoned payer contracting and value-based care executive with a demonstrated ability to build and scale enterprise payer relationships.
Established national and regional payer relationships.
Experience contracting with primary care physician groups in value-based care constructs.
Ability to create and articulate an enterprise-wide strategic vision, analyze data from varied sources, and align others with organizational strategy.
Entrepreneurial and creative approach to developing innovative ideas, with the ability to balance broad change against organizational capacity and create achievable implementation plans.
Ability to set clear, challenging goals, drive accountability and improved performance, adapt to ambiguity, and lead others through complex situations.
Sound judgment in assessing risks, seeking data and input, and making transparent, consistent decisions in the organization’s best interests.
Ability to attract, recruit, motivate, and develop talent; delegate effectively; manage performance; and persevere while maintaining high standards.
Self-awareness, openness to feedback, and commitment to continuous improvement.
Strong relationship-building, emotional intelligence, clear and persuasive communication, and ability to build trust and influence.
Dependability, ability to meet deadlines and work independently, sustained focus, and punctuality.
Strong interpersonal skills and ability to contribute to a positive work environment.
Computer proficiency and ability to learn new tools quickly.
Honesty, accountability, and ability to maintain confidentiality.

Nice To Haves

Experience with risk-bearing entities such as Aledade, Wellvana, Privia Health, or similar organizations.
Located ideally on the East Coast.
Willingness to travel 50–75% of the time.

Responsibilities

Oversee, manage, and develop the existing base of 500–600 payer contracts.
Own enterprise-wide payer contracting strategy across commercial, Medicare Advantage, Medicaid, PBMs, and regional health plans.
Lead negotiations of national and regional payer contracts.
Develop scalable contracting frameworks for vaccines, LARCs, and future physician-administered therapies.
Expand payer participation into new markets and closed-network environments, and establish preferred payer and preferred provider relationships.
Optimize reimbursement economics and contract performance; lead renewals, renegotiations, and strategic contract restructuring.
Assess current staffing focused on payer strategy and identify the team members and skill sets needed to build a dedicated team.
Design and execute VaxCare’s national value-based care strategy, including risk-sharing, incentive-based reimbursement, and outcomes-driven programs.
Develop payer offerings tied to vaccination rates, preventive-care adherence, population-health outcomes, quality measures, cost-of-care reduction, and HEDIS and STAR measures.
Build reimbursement models that reward providers for closing care gaps and develop economic models demonstrating VaxCare’s value to payers.
Build executive-level relationships with national payer leaders and mature or establish partnerships with major national and regional payers.
Create joint business plans for key accounts, executive engagement forums, and payer advisory councils; represent VaxCare as an executive spokesperson for payer and market-access initiatives.
Partner with Payer Operations, Revenue Cycle Management, and Sales/Growth teams to expand payer access and align contracting strategy with operational execution.
Lead California market expansion, including a targeted IPA engagement model, sufficient provider access and patient coverage, and collaboration with physician sales to navigate local market dynamics.
Lead strategies involving IPAs, CINs, ACOs, delegated networks, and risk-bearing entities.
Develop market-entry strategies for difficult reimbursement environments, drive network adequacy and payer participation, and create contracting playbooks for new states and products.
Define and monitor enterprise payer KPIs; develop reimbursement and profitability analytics with Finance; and establish payer performance scorecards.
Use claims, quality, and operational data to support contract negotiations and quantify payer-specific value, including improved vaccination rates, reduced care gaps, better adherence, and lower avoidable medical costs.
Improve average reimbursement across the existing contract base.
Measure and reduce payer issue-resolution volume and time to closure.
Establish Joint Operating Committees with top payers to strengthen relationships, proactively address network issues, and develop revenue-growth strategies.
Contract with new payers where gaps exist in VaxCare’s network.