Director of Payer Relations

Job SummaryReports to: Chief of Payer Solutions and RelationshipsLocation: Remote with occasional travel to network member sitesJob Type: Full-TimeCibolo Health is seeking a highly skilled, mission-driven, Director of Payer Relations to support, negotiate, implement and administer payer agreements across Value-Based Care (VBC) and Fee-for-Service (FFS) arrangements for state based high value, clinically integrated, networks (HVNs). This role focuses on ensuring contractual compliance, operational clarity and financial sustainability while supporting member networks transition toward value-based payment models that emphasize quality, access and cost stewardship.This role works collaboratively with payers, participating providers, and internal teams to operationalize contracts, support performance expectations, and resolve administrative or contractual issues. All contracting activities are conducted in accordance with applicable federal and state laws.This position is ideal for a candidate with strong technical skills, client-facing communication strengths, and experience turning data into operational execution.Key ResponsibilitiesLead and support negotiations with commercial and government payers for FFS and VBC agreements, consistent with applicable regulatory requirements.Draft, review, and administer payer contracts and amendments to ensure clarity of terms, alignment with quality and performance objectives, and compliance with governing laws and regulations.Maintain accurate, organized records of contract terms, performance requirements, and payer communications.Value-Based Care EnablementSupport the development and administration of value-based arrangements such as shared savings, bundled payments, and other performance-based models that are payer-sponsored or payer-approved.Collaborate with clinical, quality, finance, and analytics teams to operationalize payer-defined quality measures, cost benchmarks, and reporting requirements.Monitor contract compliance, including quality reporting and performance timelines, and coordinate corrective actions as needed.Participate in payer meetings focused on quality improvement, care coordination, and program performance on behalf of the network, consistent with contractual scope and governance.Financial Analysis & ReportingAnalyze reimbursement methodologies and model the financial implications of proposed payer arrangements.Assess financial performance and risk exposure under existing contracts and support mitigation planning where appropriate.Prepare performance dashboards and summary reports for internal leadership and governance committees (e.g., Business Integration, Clinical Integration, Care Coordination, Executive Leadership, and Board).Stakeholder CoordinationWork closely with internal teams (Clinical Operations, Quality, Finance, Analytics) to translate contract requirements into operational workflows.Serve as a central point of coordination between payers, participating network entities, and internal departments to address contractual, administrative, and performance-related questions.Support participating providers with escalated payer matters such as credentialing questions, reimbursement inquiries, and claims-related issues, while preserving payer and provider autonomy.Regulatory Knowledge and ComplianceEnsure contracting and performance activities align with federal, state, and payer-specific requirements, including CMS and Medicaid program rules.Stay current on evolving CMS models, ACO initiatives, and alternative payment methodologies relevant to network participants.Promote transparency, documentation, and compliance practices consistent with FTC and DOJ guidance applicable to clinically integrated and value-based arrangements.QualificationsBachelor’s degree in healthcare administration, Business, Finance, or a related field.Minimum of 5 years of experience in payer contracting, healthcare finance, revenue cycle, or related roles.Working knowledge of Fee-for-Service reimbursement, including Critical Access Hospital (CAH) and Rural Health Clinic (RHC) payment structures, and value-based payment models (e.g., shared savings, pay-for-performance, bundled payments).Strong analytical, negotiation, and written and verbal communication skills.Experience using data analytics tools and contract management systems.Preferred Experience & SkillsExperience supporting value-based or performance-based arrangements within population health or network environments.Familiarity with CMS programs, Medicaid managed care, and commercial payer contracting requirements.Ability to manage multiple concurrent projects and payer relationships in a dynamic, growth-oriented environment.Work Environment & Physical RequirementsPeriodic travel to conferences, payer meetings, and in-person events is required.Role is primarily remote, or home-office based, utilizing standard office equipment.Computer and required equipment are provided by Cibolo Health.Impact: Drive transformational change in rural healthcare through data-driven decision-making.Innovation: Work with cutting-edge population health platforms and analytics tools.Collaboration: Partner with state leaders, payers, and providers to create sustainable, high value rural health solutions.Growth: Access opportunities for professional development, research, and leadership in population health management.Join us in building healthier, more resilient rural communities through data-driven population health solutions. 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