Job Description

At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day.

We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One.

Job Title

Senior Director Payer Contracting

Location

Cleveland

Facility

Remote Location

Department

Managed Care-Finance

Job Code

T00060

Shift

Days

Schedule

8:00am-5:00pm

Job Summary

Job Details

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 and full-risk models, transplant, high-cost drug, and 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, and 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.

Minimum qualifications for the ideal future caregiver include:

• 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 for the ideal future caregiver include:

• 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.

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 Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility.

If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/

Please review the Equal Employment Opportunity poster.

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