Job Description

Job Description

WellMed Optum Florida

WellMed, part of Optum, is a physician-led healthcare organization focused on helping older adults live healthier lives. Across 94 clinics in Florida, our care teams emphasize prevention, chronic condition management and strong patient relationships. Support extends beyond the clinic, including in-home care.

Value-based care is central to our model. WellMed’s Florida network contracts directly with Medicare Advantage health plans and manages medical risk. Strong payer partnerships help sustain this model and support better patient experiences and business performance.

This Position

The VP, Payer Contracting and Relations leads payer strategy, owns executive payer relationships and holds contract approval authority within organizational governance.

Overseeing approximately five to seven priority payer partnerships, this leader establishes negotiating objectives and risk parameters, strengthens long-term relationships and holds teams accountable for financial, operational and partnership results.

The Senior Director, Payer Network Relations reports to this position and leads negotiations, implementation and ongoing partner management within the VP’s strategic framework.

Lead payer strategy and executive partnerships

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• Establish payer portfolio priorities and long-term partnership plans aligned with growth and value-based care objectives.
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• Build and sustain executive relationships with priority payers, establish shared goals and resolve escalated issues.
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• Guide payer contracting, renewals, market expansion, product design and readiness to assume financial risk.
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• Ensure payer partnerships deliver measurable value throughout the contract lifecycle.
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Set contracting direction and governance

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• Establish negotiating objectives, financial expectations, risk parameters and escalation thresholds with Finance, Actuarial, Legal and clinical leadership.
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• Review and approve proposed agreements and material changes within delegated authority, escalating decisions requiring additional approval.
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• Provide strategic direction on capitation, shared savings, shared risk, global risk, quality and gain-share incentives, and risk adjustment provisions.
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• Support high-stakes negotiations when executive engagement or resolution of material issues is needed.
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Drive performance and develop the team

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• Hold the Senior Director and supporting teams accountable for negotiation outcomes, implementation, partner performance and renewal readiness.
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• Align operations, clinical, quality, finance and network leaders around contractual commitments and improvement priorities.
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• Oversee specialty network strategy to support payer obligations, patient access, quality and cost performance.
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• Review portfolio scorecards, financial forecasts and emerging risks; present recommendations to the SVP and executive leadership.
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• Ensure contracting strategy and governance meet applicable regulatory, legal and compliance requirements.
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• Lead and develop the payer contracting and relations function.
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Required qualifications

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• Demonstrated leadership experience in payer contracting, managed care or value-based care strategy.
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• A strong record of negotiating and overseeing complex risk-based payer agreements, including capitation, shared savings, shared risk or global risk.
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• Ability to evaluate contract economics, financial forecasts and risk assumptions and translate findings into strategic decisions.
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• Demonstrated success building executive-level payer relationships and sustaining partnerships across contract cycles.
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• Experience setting contracting priorities, guiding negotiations and exercising sound judgment on approvals and escalations.
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• Ability to lead teams and align contracting, operations, clinical, quality, finance and network stakeholders.
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• Strong executive communication, negotiation and conflict-resolution skills.
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• Knowledge of Medicare Advantage, risk adjustment, quality incentives and value-based payment models.
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Preferred qualifications

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• Experience on both the health plan and provider sides.
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• Familiarity with Florida payer markets and relationships.
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• Experience with healthcare operations, specialty networks and risk-bearing primary care organizations.
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• Experience building or scaling a payer contracting and relations function.
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• A collaborative leadership approach grounded in accountability, humility and emotional intelligence.
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