Senior Director Payer Contracting

About the role

The Senior Director of Payer Contracting will shape market‑level payer strategy, lead major negotiations and renewals, and enhance the performance of a diverse contract portfolio across fee‑for‑service, value‑based, and risk‑based models. This remote position works US‑wide, supporting Cleveland Clinic’s mission to deliver patient‑first healthcare.

Key responsibilities

• Develop and execute payer strategies aligned with financial goals, reimbursement priorities, and growth objectives.
• Lead high‑stakes negotiations with market and national health plans for fee‑for‑service, shared‑savings, downside‑risk, percent‑of‑premium, full‑risk, transplant, high‑cost drug, and provider‑payer product agreements.
• Own the full contracting lifecycle from strategy and modeling through implementation, performance monitoring, renewal, and escalation.
• Build analytic frameworks to evaluate reimbursement, contract yield, utilization, total cost of care, quality performance, attribution, risk adjustment, and financial exposure.
• Lead, coach, and develop a team of contracting professionals and analysts, fostering a culture of high performance.
• Influence cross‑functional stakeholders—including physicians, finance, revenue cycle, legal, and operational leaders—to align payer decisions with enterprise priorities.

Required profile

• Bachelor’s degree in business, marketing, or a health‑care‑related field.
• At least 10 years of managed‑care experience in a payer or provider organization.
• Minimum 5 years of advanced value‑based or risk‑based percent‑of‑premium management and negotiation experience.
• Proven success leading complex payer negotiations with significant financial and operational impact.
• Deep knowledge of reimbursement methodologies, contract analytics, value‑based payment models, risk structures, and relevant legal/regulatory considerations.
• Demonstrated ability to lead teams and influence senior stakeholders in highly matrixed environments.