Director of Payor Strategy and Value

Job Details: Job Location: General and Administrative - San Diego, CA, Salary Range: $140000.00 - $160000.00Salary, ACES HISTORY:   

Founded 30 years ago by ACES Chairwoman Kristin Farmer, ACES has grown into a leading autism services platform, serving 5,000+ clients in 90+ markets across 8 states – supported by growth equity firm General Atlantic since 2020.  With a differentiated clinical model that delivers twice the outcomes per hour of any other industry provider, ACES focus is to make step-change improvements as the provider, employer and partner of choice to grow with excellence towards our vision to be the best in ABA in America. 

ROLE CONTEXT:  

ACES is building a payor strategy that will define the next 3-5 years of growth. Our objective is to articulate our differentiated clinical and operational value, secure the right contracts at the right rates for each payer, expand value-based partnerships with national and regional health plans, and execute a scalable payer go-to-market strategy that supports long-term growth.   

ACES seeks a hungry, humble and collaborative leader who is equally comfortable developing strategy and rolling up their sleeves to execute it. This individual will translate vision into action by building strong payer relationships, driving complex negotiations, identifying innovative reimbursement opportunities, and partnering cross-functionally to deliver measurable results. Success in this role requires both strategic thinking and a scrappy, entrepreneurial mindset, with a relentless focus on creating long-term value for ACES, our payer partners, and the individuals we serve. 

DETAILED JOB SUMMARY: 

The Director of Payor Strategy & Value will be responsible for co-architecting and executing on ACES’ enterprise payor strategy by leading national and state-level payor contracting, negotiations and relationships; advancing value-based and alternative payment models; translating payor contracts into scalable, compliant operational workflows; and partnering cross functionally with finance, operations, growth, and clinical leadership to drive the best client outcomes, client growth, market expansion and margin expansion. 

RESPONSIBILITIES*: 

Payor Strategy & Value: 

Co-architect and implement strategically valuable and economically sustainable payor strategies: 

Contracting roadmap for commercial payors, Medicaid MCOs, regional centers, school districts 

Advance value-based and alternative payment models (P4P, bundles, outcomes-based arrangements), translating clinical quality and access metrics into defensible economic value 

Develop state-specific payor playbooks for priority and emerging markets with Field/Growth Ops 

Execute on payor strategy action plans, including building cross functional action plans that maintain or strengthen relationships with key payors  

Set and manage to geography-specific payor-mix goals 

Manage payor negotiations end-to-end, including rate setting, contract structure, escalators, carve-outs and amendments 

Drive conversations with stakeholders for regular rate review and negotiation, bringing in senior executives to support when needed/additive 

Report-outs on performance, opportunities and risk to executive team and key stakeholders  

Payor Relations: 

Manage and create win-win payor relationships, serving as the primary interface, to position ACES as the best in ABA and a data-driven partner in early intervention and medically necessary ABA services 

Ensure high-level engagement, leveraging ACES leaders to strategically enhance relationships  

Represent and advocate for ACES “ABA product” 

Identify and mitigate payor-related risk, including adverse policy changes, utilization management friction, denials and reimbursement erosion—proactively escalating and resolving issues 

Payor Margin Management: 

Partner with Data and Analytics team to forecast and evaluate the results of strategic options 

Analyze trends for business opportunities and market clinical/business changes 

Model rate changes and forecast payor mix impacts and profitability by payor; develop perspective on financial levers to pull through payor contracting, e.g. indirect hours impact, mid-tiers, overlaps, VBC, etc 

*List of responsibilities is not meant to be exhaustive. ACES can modify this job description/responsibilities at any time and in its sole discretion.  

ACES LEADERSHIP BEHAVIORS:   The person in this role models ACES’ values and Leadership Behaviors:  

S olve for “We v. Me” 

C ontinuously Improve 

A ct with Accountability 

L ead with Purpose  

E xpect Excellence 

S tay Humble and Empathetic 

Qualifications: EXPERIENTIAL CRITERIA: 

Direct experience negotiating and structuring alternative reimbursement models and value-based care agreements (shared savings, risk corridors, quality-based bonuses, case rate/bundled models)  

Has built partnerships and problem solved with a growth mindset to drive growth (volume, rate) 

Operated intersection of strategy and payor relations — i.e., informed enterprise strategy (market entry, M&A targets, service line expansion) and executed it through contracts 

Translated strategy into cross-functional, detailed action  

Obsession for win-win value creation and translating ACES’ vision and purpose into growth to ensure ACES and payor return on investment 

Fluent in translating company needs and clinical model with payors and visa versa  

Creative thinker, problem solver and dot connecter to envision/capitalize on payor/employer solutions 

Cross-functional collaborator; quickly builds trust and rapport 

High learning agility with natural orientation to continuously improve results 

Owner mentality who can make progress without significant support or direction 

QUALIFICATIONS: 

Bachelors or Master’s degree with 6-10 years experience in professional or multi-site healthcare business in strategic payor role strongly preferred  

Alternative payment methodologies experience (e.g. pay for performance, value-based care) highly preferred with demonstrated track record/outcomes 

3-5 years demonstrated leadership and cross-functional experience, preferably within a payor team 

High level organizational skills, with strong attention to detail  

Curiosity: Listening and learning mindset  

Distinguished interpersonal, communication (oral, written) and problem-solving skills 

Professional selling skills – able to translate value of ACES clinical product/model to a Payor partner 

Metrics-Driven: Strong accountability, with proven success in meeting timelines and deliverables  

Applied behavior analysis (ABA) experience and related licensure a plus 

Ability to travel as required 

PHYSICAL REQUIREMENTS: 

Ability to exert up to 10 pounds of force and lift/move up to 15 pounds 

May include, without limitation, physical demands: sitting, typing, screen viewing for extended periods