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Vice President, Payer Contracting

Somatus

Somatus

Virginia, USA · McLean, VA, USA · United States
Posted on Sunday, June 23, 2024
Overview

As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home.

It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you?

Showing Up Somatus Strong

We foster an inclusive work environment that promotes collaboration and innovation at every level. Our values bring our mission to life and serve as the DNA for every decision we make:

  • Authenticity: We believe in real dialogue. In any interaction, with patients, partners, vendors, or our teammates, we are true to who we are, say what we mean, and mean what we say.
  • Collaboration: We appreciate what every person at Somatus brings to the table and believe that together we can do and achieve more.
  • Empowerment: We make sure every voice gets heard and all ideas are considered, especially when it comes to our patients’ lives or our partners’ best interests.
  • Innovation: We relentlessly look for ways to improve upon the status quo to continuously deliver new solutions.
  • Tenacity: We see challenges as opportunities for growth and improvement — especially when new solutions will make a difference for our patients and partners.

Showing Up for You

We offer more than 25 Health, Growth, and Wealth Work Perks to help teammates learn, grow, and be the best version of themselves, including:

  • Subsidized, personal healthcare coverage (medical, dental vision)
  • Flexible Paid Time Off (PTO)
  • Professional Development, CEU, and Tuition Reimbursement
  • Curated Wellness Benefits supporting teammates physical and mental well-being
  • Community engagement opportunities
  • And more!

As the Vice President of Payer Contracting Strategy within the Business Development team, you will lead and execute the Company’s payer contracting strategy, including, but not limited to, Commercial, Medicare Advantage, and Medicaid plans, and oversee the development of new initiatives to enhance payer value and alignment for value-based care programs. This role will report to the SVP PE and BD.

This position requires you to be on site at our HQ in Mclean, VA.


Responsibilities

  • Drive creative and alternative pricing and contract structures to ensure value to the payer and profitable for the company.
  • Lead the company’s payer contracting strategy, and actively pursue and drive the development and execution of profitable agreements across Medicare Advantage, commercial insurance, Medicaid and Medicare FFS (direct contracting).
  • Oversee the development of short and long term cross-payer contracting strategies, such as: broker services, health plan marketing, benefit design integration, high-value network offerings, health plan value-reporting and regional, multi-payer initiatives.
  • Maximize efficiency and standardization of the payer contracting and pricing process for the company by establishing internal contract valuation and reporting methodologies to assess current and future total contract value and relative risk by line of business.
  • Manage and drive, in collaboration with the company’s clinical, operations, and finance teams, overall value based care contracting with payers and other risk bearing entities.
  • Develop proforma models of contracts that show variability in revenue and EBIDTA by taking on different types of risk contracts from PMPM one end of the spectrum to full risk on the other end.
  • Lead and participate in contract negotiation discussions with health plan prospective customers
  • Develop renewal strategies for long-term arrangements. Determine the effectiveness of arrangements with long-term clients and recommend appropriate changes for updates to renewals

Management:

  • Execute and negotiate complex commercial agreements with health plans, evaluate contract economics, and develop creative growth strategies. This includes determining performance goals and managing workflows, etc.

Thought Leadership & Reporting:

  • Advise senior leadership and other enterprise-wide stakeholders on payer strategy, positioning, emerging trends, contracting methodologies and risk assessment and act as a strategic thought leader and partner for internal and external stakeholders

Qualifications

Required Education & Experience

  • A Master’s Degree in Health Care, Public Health or Business Administration is preferred.
  • 10+ years related experience in a managed care payer environment with a minimum of 5 years management or leadership experience in value-based care.

Preferred knowledge, skills, and/or abilities:

  • Prior experience as a thought leader and participation on industry panels
  • In-depth knowledge of the payer market including commercial, Medicare and Medicaid.
  • Strong, results-oriented leadership ability in a fast paced, matrix organization.
  • Strong financial and operational acumen and understanding of profitability drivers and medical cost trends that drive gains and losses across risk pools.
  • Ability to recognize and execute on growth opportunities across payers and markets and adapt business development and contracting approaches, as needed.
  • Proven track record of creating, maintaining, and enhancing customer relationships and communicating effectively with senior management.
  • Passionate about driving the shift from fee-for-service to value-based care.
  • Track record of leading teams through “white space” strategic issues, developing frameworks that guide teams to solutions, and implementing those solutions.
  • Ability to think beyond your immediate team and contribute to making Somatus holistically better (active engagement in DE&I efforts, culture initiatives, facilitating training, leading roundtables, etc.).

Physical Requirements:

  • Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
  • Ability to travel 25%-65%

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Our priority is the health and safety of our members, colleagues, partners, and community. Proof of COVID-19 Vaccination is required for employment. If you are unable to be vaccinated for medical reasons or sincerely-held religious beliefs, we will consider requests for reasonable accommodations consistent with our policy, and where we are able to provide such accommodations without undue hardship to the company pursuant to applicable law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated.