At Pediatric Home Service, we help medically complex kids live their best lives, at home, with their families. As a national leader in pediatric home care, we offer a full range of services including infusion, clinical nutrition, respiratory therapy, PPEC, private duty nursing, and DME. Whether you're caring for patients or supporting behind the scenes, every role at PHS makes a difference. Join a mission-driven team that’s committed to putting children and families first.

• Position: Senior VP of Payer Strategy & Market Access
• Location: Roseville, MN
• Hours: Monday-Friday, 8am-5pm

POSITION DETAILS:

The Senior Vice President (SVP), Payer Strategy & Market Access provides executive leadership to advance Pediatric Home Services' market position through strategic payer relationships and comprehensive contract networks. This leader develops and executes a national payer strategy aligned with PHS’s clinically driven care model for medically complex pediatric populations, ensuring complete and competitive networks across all markets. The SVP negotiates above-market reimbursement rates that reflect the intensity and quality of services delivered and advances innovative payment models tailored to pediatric complexity, while building national and regional partnerships that support long-term growth.

Working in close collaboration with Advocacy, Legal, Finance, Operations, Executive leadership, and Revenue Cycle, the SVP aligns contract strategy with enterprise objectives, ensures leaders are informed of payer developments impacting service delivery and financial performance, and resolves escalated reimbursement and payment integrity issues. Serving as the executive face to commercial and managed care payers, this role ensures contract structures, policies, and payment methodologies reflect the unique needs of the pediatric population PHS serves.

Job Duties

Strategic Payer Leadership

• Provides executive oversight and strategic leadership to a team of Vice Presidents, Payer Relations, setting enterprise priorities, driving performance accountability, and ensuring consistent execution of payer engagement initiatives across all markets.
• Develops and executes a national payer strategy designed to secure complete contract networks in all current and expansion markets.
• Advances PHS’ competitive position by negotiating reimbursement rates that exceed market averages and appropriately reflect clinical complexity, intensity of service, and quality outcomes.
• Positions PHS’ comprehensive, clinically driven care model as differentiated and essential within payer networks.
• Establishes and maintains national payer relationships to ensure consistency in contract structure, rate methodology, and payment policy.
• Designs and implements innovative payment arrangements, including value-based or alternative reimbursement models, aligned with pediatric population complexity.
• Ensures payer contracts include terms and policies tailored to medically complex pediatric populations, including coverage criteria, authorization parameters, and documentation standards appropriate to care intensity.

Contracting & Negotiations

• Oversees the full payer contract lifecycle to ensure competitive, strategically aligned agreements that strengthen PHS’ market position.
• Leads complex negotiations including reimbursement methodology, rate escalators, pediatric-specific payment policies, network adequacy strategy, and innovative payment models.
• Secures contract language that reflects the unique clinical needs of medically complex pediatric patients.
• Ensures PHS maintains complete and strategically advantageous network participation in all service areas.
• Partners with Finance to model rate scenarios and evaluate financial impact of proposed contract terms.
• Partners with Legal to structure enforceable and strategically favorable contract provisions.

Payer Performance & Escalation Management

• Partners with Revenue Cycle leadership to resolve escalated payer issues impacting reimbursement, denials, or operational performance.
• Monitors payer trends, payment accuracy, and denial patterns to identify systemic concerns.
• Implements corrective strategies in collaboration with internal departments and payer representatives.

Cross-Functional Collaboration

• Collaborates with Executive, Finance, and Operations to align payer initiatives with organizational strategy.
• Collaborates with Advocacy to align payer strategies with broader access and market initiatives.
• Partners with Revenue Cycle leadership to resolve escalated payer issues related to claims adjudication, denials, underpayments, or systemic payment barriers.
• Educates internal teams on payer developments and reimbursement changes that impact current and future operations.
• Provides executive visibility into payer trends that may influence operational planning, expansion strategy, or service model evolution.

Data Analysis & Reporting

• Coordinates the collection, analysis, and documentation of data related to payer initiatives, performance, and strategic projects.
• Develops dashboards, reports, and executive summaries to inform leadership decision-making.
• Creates and maintains contract tracking systems, spreadsheets, and databases to support contract lifecycle management.

Communication & Representation

• Prepares and delivers written, verbal, and visual presentations for executive leadership and external stakeholders.
• Drafts and reviews correspondence including letters, memoranda, formal notifications, and strategic communications to payers.
• Represents the organization at industry events, meetings, and networking opportunities to strengthen strategic partnerships.

Confidential & Executive Responsibilities

• Exercises independent judgment and discretion in matters of a highly confidential and strategic nature.
• Advises executive leadership on payer risks, opportunities, and market intelligence.
• Leads and mentors payer relations staff, establishing performance standards and accountability measures.

Supervisory Responsibilities: Supervises assigned staff. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

REQUIREMENTS

Education and/or Experience:

• Bachelor’s degree required; Master’s degree in Healthcare Administration, Business Administration, Finance, or related field preferred.
• 10+ years of progressive leadership experience in payer relations, managed care contracting, or healthcare revenue cycle.
• Demonstrated success negotiating competitive reimbursement rates ad complex contract structures.
• Experience developing national payer relationships and executing multi-market contracting strategies.
• Deep understanding of reimbursement methodologies, regulatory requirements, and healthcare financial operations.
• Proven ability to structure innovative payment arrangements aligned with clinical outcomes and service complexity.
• Strong analytical skills, negotiation skills, executive presence, and ability to influence senior payer leadership.

BENEFITS

• Generous Paid Time Off (PTO) for full time employees to ensure a healthy work-life balance
• 401(k) Matching to help secure your future
• Tuition Reimbursement to support your educational and professional growth
• Professional Development & Learning Opportunities to expand your skills and knowledge in pediatric care
• Health and Dental insurance
• Short & Long Term Disability and Life Insurance

SALARY RANGE:

At PHS, we are committed to providing specialized care for medically complex children. Every role, from direct patient care to customer support, plays a vital part in improving the lives of kids and families. The impact you make is invaluable. We are dedicated to offering fair and transparent compensation to our team members. The starting rate for this role is $153,859 annually, based on experience and qualifications.

Interested candidates should apply online at http://www.phscareers.com.

We look forward to learning more about you & the skills you can bring to Pediatric Home Service!

Pediatric Home Service is an equal opportunity employer; we are committed to affirmative action and equal employment opportunities for all regardless of protected veteran status, race, color, creed, religion, national origin, sex, sexual orientation or identity, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance.