(S)VP, Medicare Advantage
Who we are. . .
Pearl Health is restoring the independence and joy of practicing medicine for doctors in the United States. Our healthcare system has burdened our doctors with too much process, while removing them from what they do best: caring for those we love most. We are a team of physicians (Groups), technologists (Athena, Hudson River Trading) and health plan leaders (Oscar, Clover, Centivo) who believe that primary care providers (PCPs) are the key to the United States’ future health. Our investors include Andreessen Horowitz, Viking Global Investors, AlleyCorp, and SV Angel.
Pearl Health helps PCPs who are overwhelmed by the demands of an aging population and the unpredictable business model inherent to Traditional Medicare. Over time, this solution will empower PCPs to provide better care to their entire patient population. We believe there is a need to bring humanism back to healthcare by giving physicians the ability to better allocate their time with patients, increasing their autonomy, creating incentives that are aligned with achieving better outcomes through clinical decision-making powered by actionable intelligence, and making risk more available and more readily optimized through an intelligent marketplace. The Center for Medicare and Medicaid (CMS) is launching a new value-based care program to disrupt Traditional Medicare, and we believe that this represents an opportunity to achieve the meaningful change we envision.
What we hope you can do…
We are seeking an exceptional healthcare leader who is eager to lead the build of our second line of business. Your core focus will be driving the expansion of our value-based primary care offering to Medicare Advantage patients by helping design and execute our strategy to establish value-based partnerships with Medicare Advantage plans, thereby consolidating our offering to providers across Medicare.
You will oversee and work collaboratively with our Head of Payor Operations, forging internal alignment across our Product, Growth, and Operational teams to empower Pearl to land 1-3 key partnerships for performance year 2024, expanding Pearl into a new line of business alongside our traditional Medicare book. We are seeking someone who can nurture critical relationships with key leaders at potential MA plan partners, informing our go-to-market strategy, negotiating advantageous value-based contracts with payors, empowering our Growth team to expand our offering to PCPs across the country by ensuring our offerings meet the necessary requirements for success. You will ensure our MA partnerships align with Pearl’s technology priorities and operational capabilities and that they help the company achieve its broader objectives, including guiding the strategy around implementation and operational excellence. We are looking for someone who has a strong understanding and vision for how Pearl and our provider partners can succeed in value-based Medicare Advantage.
This position requires strategic thinking, project design, organizational development, understanding of actuarial and healthcare economics, and entrepreneurship. You should be eminently comfortable with the Medicare Advantage landscape, go-to-market concepts and playbooks, expansion of a book of business, and strategic thinking and collaboration with relevant teams to facilitate good decision making in a lean operating environment. We expect a substantial aspect of this leadership position will involve leveraging a strong existing network to open doors and an ability to forge relationships with the most senior players in Medicare Advantage, while also driving best practices in strategic and operational rigor, enabling continued success in the ongoing partnerships with payors post-close.
What a (S)VP of Medicare Advantage means to us...
- Play a key role in developing Pearl’s go-to-market strategy, value proposition, and pitch for MA Plans, in partnership with our Growth and Payor Operations teams.
- Leverage existing rolodex to build a strong payor pipeline
- Keep management educated on the latest macro developments, strategic evolutions and relevant payor strategy updates (general market intelligence).
- Build, manage, and execute against a prioritized payor prospect funnel, leveraging preexisting relationships with key targets to achieve growth goals
- Facilitate and contribute to a feedback loop based on learnings from payor targets, based on direct prospect reactions, synthesized insights, and other critical data points, partnering with our Head of Payor Operations to proliferate these learnings throughout Pearl
- Serve as steward of sales process for payors, ensuring that key actions, deliverables, and analysis are delivered on a timely basis to achieve enterprise-focused sales objectives
- Demonstrate aptitude for relationship building and creating an exceptional experience for our providers.
- Lead contract negotiation processes and be plan-facing Pearl sponsor of negotiations, ensuring feedback loop to Payor Operations to ensure contracts align to internal capabilities and commitments.
- Translate final deal into provider-facing contracts in partnership with Legal.
- Translate provider-facing contracts into provider-facing GTM materials in partnership with Growth, Marketing, Payor Operations & CS.
- Identify local and market-specific insights; willingness to travel to assigned geographies for live prospecting
- Attend networking events, community events and conferences to grow relationships
- Work across the organization productively, to ensure successful implementation of this critical project
- Oversee the implementation of new MA partnerships
- Partner with our Head of Payor Operations to ensure ongoing growth of the payor operations and payor relationships
Who you are…
- 10+ years of experience in network contracting and development or other relevant payor leadership-facing field. Experience with ACOs is a plus.
- Operational leadership experience is required; a plus if this includes experience in the Medicare Advantage space.
- Excellent communication, interpersonal and presentation skills.
- You are relentless, but patient. You are constantly hunting for prospects but also understand that the contracting cycle requires lots of touches with potential partners.
- A passion for improving and optimizing relationships.
- Excited about helping physicians benefit from the value they bring to the healthcare system.
- Willingness to travel for internal company meetings and prospect/customer site visits, as needed.
- Bachelor’s degree or equivalent work experience.
We are an Equal Opportunity Employer and our employees are people with different strengths, experiences and backgrounds, who share a passion for improving people's lives. Our definition of diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. We believe all of our colleague’s points of view are integral to our success, and that inclusion is everyone's responsibility and a cause of beautiful things.
We welcome candidates from all backgrounds and are committed to a fair hiring process free from discrimination and focused around problem solving, improvement, and mutual empowerment.
We are a remote-first company, with concentrations of team members at our NYC headquarters and in the Boston area.
If a resume is submitted to any Pearl Health employee by a third party without a valid written and signed search agreement, it will become the property of Pearl Health and no fee will be paid, irrespective of whether the candidate is hired.
Compensation and Benefits
The salary range Pearl Health expects to pay for this position is between $210,000-$300,000 per year. Full time employees are also eligible for annual discretionary bonus. Where a given candidate falls within that range will depend on a variety of factors, including, but not limited to, the candidate’s relevant skills, experience and location, labor market conditions and participation, if any, in other compensation arrangements. Pearl Health provides its employees a competitive benefit package. For more information click here: Pearl Health Benefits.