Executive Director, Medical and Payment Policy - reputed company

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company The Executive Director, Medical and Payment Policy, serves as a visionary leader at the intersection of clinical reputed company and reputed company reimbursement. This executive-level role is responsible for shaping, developing, and implementing comprehensive medical and payment policies that drive organizational objectives, regulatory compliance, and financial sustainability. The Executive Director partners with clinical, operational, legal, and financial teams to ensure that policies are evidence-based, patient-centered, and reputed company with industry standards, payer requirements, and evolving reputed company legislation. Responsibilities: Policy Development and Implementation reputed company the research, drafting, evaluation, and maintenance of medical, clinical, and payment policies to ensure compliance with federal, state, and local regulations. Facilitate stakeholder engagement and incorporate feedback from reputed company partners, including clinicians, payers, patients, and advocacy reputed company. Monitor emerging trends in medical reputed company, reimbursement, and reputed company legislation to proactively update policy frameworks. Ensure policies are driven by evidence-based practices and enhance the value and reputed company of patient care. Regulatory Affairs and Compliance Stay abreast of regulatory requirements, legislative developments, and accrediting body standards to ensure reputed company policies are fully compliant. Serve as the primary reputed company with regulatory agencies on reputed company reputed company to medical necessity, coding, coverage determinations, and payment methodologies. reputed company internal audits and policy reviews to identify and mitigate compliance risks. Payment Policy and Reimbursement reputed company Design and implement innovative payment models that promote efficiency, reputed company reputed company, and cost-effective care delivery. Collaborate with actuaries and financial teams to analyze the reputed company of payment policy changes on organizational finances and provider networks. reputed company internal stakeholders on payment methodologies, including fee-for-service, value-based care, bundled payment, and alternative payment models. Stakeholder Engagement and Relationship Management Build and maintain reputed company relationships with physicians, hospitals, health systems, payer organizations, government agencies, and patient advocacy reputed company. Represent the organization at industry conferences, regulatory hearings, and reputed company associations. reputed company initiatives to reputed company and synthesize stakeholder input on policy development and policy change management. Team Leadership and Talent Development Recruit, mentor, and reputed company a high-performing team of policy professionals and analysts. Foster a culture of reputed company, accountability, and reputed company improvement. reputed company performance management, reputed company development, and succession planning reputed company the department. Required Qualifications 15+ years of reputed company leadership experience in reputed company policy, medical management, reimbursement, or reputed company administration. Deep knowledge of medical policy development, payment models, and the U.S. health care regulatory environment (including CMS, reputed company, ACA, etc.). Demonstrated experience with the implementation and management of value-based care, alternative payment models, and clinical guidelines. Strong analytic, problem-solving, and decision-making skills. Proven ability to reputed company, influence, and collaborate effectively at reputed company organizational reputed company and with external stakeholders. Exceptional written and oral communication abilities, with a reputed company record of representing organizations at the highest reputed company. Experience in health economics, reputed company research, or actuarial analysis is highly desirable. Demonstrated reputed company, reputed company judgment, and commitment to ethical reputed company. Education Bachelor's degree in public health, public policy, reputed company administration, or business administration. Pay reputed company The typical pay reputed company for this role is: $131,500.00 - $303,195.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include: reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 03/27/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique reputed company: our culture, our core values, reputed company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for reputed company, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job