[Hiring] Senior Director Payer Contracting @Cleveland Clinic

Role Description

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.

As Senior Director, Payer Contracting, you will help set and execute market-level payer strategy, lead major negotiations and renewals, and strengthen the performance of a diverse contract portfolio. You will protect and improve reimbursement, contract yield, total cost-of-care performance, and enterprise value across commercial arrangements, including:

• Fee-for-service
• Value-based care
• Percent-of-premium
• Full-risk models
• Transplant
• High-cost drug
• Joint product agreements

You will lead a team of contracting professionals and analysts while partnering with:

• Physicians
• Clinical institutes
• Finance
• Revenue Cycle Management
• Clinical Transformation
• Clinically integrated networks
• Product
• Payment Innovations
• Legal
• Operational leaders

Your work will align payer decisions with financial, clinical, operational, and market priorities—and translate strategy into measurable results.

A caregiver in this role works remotely across the US from 8:00 a.m. – 5:00 p.m.

A caregiver who excels in this role will:

• Develop and execute payer strategies that reflect market position, financial goals, reimbursement priorities, growth objectives, and organizational risk tolerance.
• Lead high-stakes negotiations and renegotiations with market and national health plans across fee-for-service and advanced value-based arrangements.
• Structure and negotiate shared-savings, downside-risk, percent-of-premium, full-risk, transplant, high-cost drug, and provider-payer product agreements.
• Own the contracting life cycle—from strategy and modeling through negotiation, implementation, performance monitoring, renewal, and escalation.
• Build analytic frameworks that evaluate reimbursement, contract yield, utilization, total cost of care, quality performance, attribution, risk adjustment, and financial exposure.
• Lead, coach, and develop contracting professionals and analysts, creating clear priorities, accountability, and a culture of high performance.
• Influence across clinical, financial, legal, operational, and executive stakeholders to resolve competing priorities and achieve enterprise-wide outcomes.
• Strengthen payer accountability and executive relationships while identifying opportunities for market growth and innovative partnerships.
• Other duties as assigned.

Qualifications

• Bachelor’s degree in business, marketing, or health care related field
• Ten years of managed care experience in a payer or provider organization.
• Five years of advanced value-based care or risk-based percent of premium management and negotiating experience in a payer or provider setting.
• Demonstrated success leading complex payer negotiations with significant financial, operational, and market implications.
• Deep knowledge of reimbursement methodologies, contract analytics, value-based payment models, risk structures, managed care policy, and relevant legal and regulatory considerations.
• Proven ability to lead teams and influence senior stakeholders in fluid, highly matrixed environments.

Preferred Qualifications

• Master’s degree
• Experience with a payer, provider organization, or large health system

Physical Requirements

• Ability to communicate and exchange accurate information.
• Ability to perform work in a stationary position for extended periods.
• Ability to work with physical records or operate a computer or other office equipment.
• In some locations, ability to travel throughout the hospital system.
• In some locations ability to move up to 25 lbs.

Personal Protective Equipment

Follow standard precautions using personal protective equipment as required for procedures.

Equal Opportunity Employment

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic is pleased to be an equal employment opportunity employer.