Job Summary
Reporting to the EVP, Chief Financial Officer, the Senior Vice President (SVP) of Managed Care and Payer Solutions is an enterprise-level leader responsible for shaping BSWH’s strategy and performance across commercial payers, government payers, value-based care (VBC) arrangements, and employer-based offerings.
- This role serves as the system’s strategic architect for payer and customer value creation—integrating strategy, pricing, analytics, network performance, and operations to improve affordability, quality, access, and the overall customer experience.
- The SVP drives strategic direction, growth, and operational performance for payer initiatives while partnering closely with Care Coverage leadership on employer offerings and VBC arrangements, and with the System CFO and other enterprise leaders on value and long-range financial planning.
- A critical component of the role is leading enterprise progress on the company-level Objective and Key Result (OKR) for clear and consistent pricing, aligning contracting, product design, revenue cycle, and market strategy.
- The SVP also advances BSWH’s payer analytics maturity in close partnership with the Revenue Analytics / Revenue Intelligence Unit (RIU) to enable payer-level insights that strengthen contract performance, negotiation strategy, and enterprise financial predictability.
- The SVP partners closely with the BSWH Quality Alliance and Direct-to-Employer (DTE) teams to deliver one integrated, enterprise-wide value delivery model.
Key Responsibilities
Enterprise strategy, leadership & integration
- Lead and manage payer, employer (in close partnership with the SVP Care Coverage), and pricing strategy functions.
- Serve as the system’s strategic architect for payer value creation and ensure alignment with BSWH’s enterprise strategy and long-range financial plan.
- Drive execution on multi-year strategic roadmaps with priority payers and ensure cross-functional alignment across contracting, product, revenue cycle, market strategy, and operations.
- Work effectively in a highly matrixed environment (including Care Coverage leaders such as Employer Solutions Portfolio leadership) to align VBC contracting, DTE initiatives, and related digital/operational enablers.
Strategic payer partnerships & friction reduction
- Cultivate enterprise-level, high-impact strategic partnerships with key commercial and government payers.
- Reduce administrative friction, improve administrative efficiency, and enhance customer/member/employer experience through end-to-end payer collaboration.
- Deliver measurable value through joint operating models, service-level expectations, and shared performance goals.
Enterprise pricing strategy & pricing OKR ownership
- Serve as executive owner of the enterprise OKR for clear and consistent pricing.
- Establish and sustain pricing governance and discipline across payer, employer, and VBC solutions.
- Integrate pricing strategy into payer negotiations, product design, and market strategy to improve transparency and predictability.
Business development, new markets & growth
- Oversee growth and expansion of payer relationships and products, including VBC components within payer arrangements.
- Partner with Care Coverage leadership to shape DTE opportunities and drive pricing and growth for employer product lines.
- Identify and execute new contracting and partnership opportunities that advance enterprise value and market position.
Integration with ACO, Quality Alliance & Direct-to-Employer teams
- Create and support unified strategies across payer, accountable care/ACO, Quality Alliance, and DTE teams.
- Partner with ACO leadership to optimize risk models and performance across risk-bearing arrangements.
- Co-design employer products and value propositions with DTE and Care Coverage partners to deliver an integrated value delivery model.
Managed care & value-based care strategy
- Expand and optimize managed care partnerships across all market segments.
- Advance VBC strategy and execution in close coordination with Care Coverage leadership and relevant product leaders to ensure clear communication of VBC terms and operational readiness for performance.
Financial oversight, contract performance & governance
- Oversee financial outcomes for payer and employer contracts, including VBC contract components.
- Ensure rate adequacy, contract governance, and disciplined performance management against established key performance indicators (KPIs).
- Engage routinely with Care Coverage and other operational leaders (including third-party risk product leadership) to align contract terms with delivery system execution and performance.
Analytics partnership & performance insights
- Advance payer analytics maturity with the Revenue Analytics / RIU teams to deliver sophisticated payer-level insights.
- Strengthen negotiation insights, rate yield analysis, contract compliance monitoring, and enterprise financial predictability through data-driven decision-making.
Operational excellence, policy development & compliance
- Lead implementation of managed care policy and operational goals across the enterprise.
- Ensure regulatory and contractual compliance and promote consistent operational performance with payers and employers.
External representation & industry leadership
- Represent BSWH with payers, employers, and policymakers.
- Influence regulatory policy and market direction through advocacy and industry leadership.
Key Success Factors
- Deep expertise in payer strategy, managed care, value-based payment models, and employer/direct-to-employer solutions.
- Proven track record leading enterprise-level payer partnerships and executing multi-year strategic roadmaps.
- Strong financial and strategic acumen with analytics fluency and comfort partnering with revenue analytics/intelligence teams.
- Ability to operate effectively in a highly matrixed environment to align pricing, contracting, revenue cycle, market strategy, and VBC/DTE initiatives.
- Demonstrated capability to reduce administrative friction and improve customer experience through operational integration and performance governance.
Minimum Qualifications
- Bachelor's Degree
- 7 Years of Experience