Vice President & Head of Payer Strategy

Location: New York

It's fun to work in a company where people truly BELIEVE in what they're doing!

We're committed to bringing passion and customer focus to the business.

Summary
** This is a remote position, but must reside in the Northeast
**** Prior experience in a hospital system or urgent care environment is strongly preferred
** PM Pediatric Care is scaling a behavioral health platform to address the mental health crisis facing children and adolescents. We operate state-based clinical pods across New York, New Jersey, and Florida, with national expansion underway. Over the next 24 months, we are growing from 75K to 150K+ annual visits and $15M to $50M+ in revenue.

The VP & Head of Payer Strategy is the enterprise payer strategist and chief negotiator for PM Pediatric Care's Urgent Care and Behavioral Health service lines. This role owns national payer relationships, contract strategy, rate negotiations, multi-state expansion, and value-based partnership development. You will serve as the executive voice to Tier 1 payers, BCBS plans, Medicaid programs, and value-based care organizations.

You will operate at the intersection of clinical strategy, financial performance, and market access, translating clinical quality and patient outcomes into payer value propositions, negotiating contracts that balance network inclusion with financial sustainability, and building partnerships that position PM Pediatrics for long-term advantage.

Reports to:

Chief Commercial Officer. Partners closely with: SVP Operations (Urgent Care and Behavioral Health), VP Clinical Programs, Finance/FP&A, and Revenue Cycle Management.

This is a high-visibility executive role with direct exposure to the CEO, Board of Directors, and national payer C-suites.

Description Responsibilities National  Payer Strategy & Tier 1 Relationship Leadership (Urgent Care) — 40%
Own strategic relationships with Tier 1 payers:
United Healthcare, Aetna, Cigna, Anthem/BCBS, and Humana; serve as executive liaison to payer leadership at the C-suite and senior VP levels

Negotiate multi-year rate renewals, expand geographic coverage, and improve contract terms including facility fees, after-hours differentials, and coding/billing policies

Lead escalation management: resolve contract disputes, address network adequacy issues, and navigate audit and compliance challenges

Translate clinical quality, patient satisfaction, and cost-effectiveness into compelling payer value propositions

Analyze rate structures, benchmark against market, and identify opportunities for rate improvement

Align contract strategy with operational footprint, utilization patterns, and market expansion plans in partnership with SVP Urgent Care Operations Behavioral Health Contract Expansion & Multi-State Market Entry — 35%
Accelerate behavioral health payer contracting in NY, NJ, and FL, and lead payer entry into 6+ new states over 24 months

Negotiate rates, terms, and coverage policies that support financial sustainability, with a target of $200K–$280K revenue per clinical FTELead payer credentialing and network inclusion strategy for therapists, psychiatrists, and psychiatric NPs across multiple states; drive credentialing cycle time to under 45 days Navigate state-specific contracting landscapes including Medicaid managed care, state employee health plans, regional commercial payers, and telehealth reimbursement policies

Leverage urgent care relationships to unlock behavioral health contracting opportunities using an integrated care value proposition

Design and execute a behavioral health payer entry playbook covering market landscaping, contract negotiation sequencing, credentialing project management, and post-contract optimization

Value-Based Care & Strategic Partnership Development — 20%
Evaluate and…