Vice President, Payer & Government Relations

At Pediatric Home Service, we help medically complex kids live their best lives, at home, with their families. As a national leader in pediatric home care, we offer a full range of services including infusion, clinical nutrition, respiratory therapy, PPEC, private duty nursing, and DME. Whether you're caring for patients or supporting behind the scenes, every role at PHS makes a difference. Join a mission-driven team that's committed to putting children and families first.

• Position: Vice President, Payer & Government Relations

• Location: Minnesota, Texas, Kansas, Florida

• Fully Remote

• Hours: Monday-Friday, 8am-5pm

POSITION DETAILS:

The Vice President, Payer & Government Relations is a highly visible strategic role responsible for advancing PHS's payer relationships, reimbursement strategy, government affairs, and public policy priorities.

This leader will manage relationships with health plans throughout the payer contract lifecycle, negotiate sustainable agreements, monitor payer performance, and partner with Revenue Cycle and operational leaders to resolve complex payer issues.

The VP will also represent PHS with policymakers, legislators, state agencies, trade associations, coalitions, and other external stakeholders to advocate for policies that support medically complex children and the services they depend on.

Internally, this position serves as a trusted resource to executive leadership and teams across PHS, translating complex payer, legislative, regulatory, and public policy developments into clear business implications and actionable strategies.

Job Duties

Payer Strategy & Contracting

• Build and maintain strategic relationships with health plans and other payer partners

• Manage the payer contract lifecycle to support sustainable reimbursement for PHS services

• Lead and support payer contract negotiations, renewals, and strategic discussions

• Monitor payer performance and identify reimbursement, contractual, and operational issues

• Partner with Revenue Cycle and operational teams to resolve escalated payer issues

• Analyze payer requirements, reimbursement trends, and contractual changes to understand their impact on PHS

• Advocate for reimbursement structures and payer policies that support access to high-quality pediatric home-based care

• Educate internal stakeholders on significant payer developments and their operational impact

Government Relations & Public Policy

• Monitor proposed legislation, regulations, and public policy developments that could impact PHS, our employees, or the children and families we serve

• Analyze legislative and regulatory developments and translate them into potential business and operational impacts

• Develop and support advocacy strategies that advance PHS priorities

• Build awareness and support for PHS services among policymakers, legislators, government agencies, and other key stakeholders

• Represent PHS with trade associations, coalitions, state agencies, legislative committees, and other external organizations

• Develop relationships with individuals, groups, agencies, and officials who influence healthcare policy and reimbursement

• Participate in legislative and regulatory discussions and advocate for policies that support access to care for medically complex children

• Coordinate internal responses and strategies related to emerging legislative and regulatory issues

Strategy, Education & Executive Partnership

• Serve as a subject-matter resource to executive leadership on payer, reimbursement, legislative, regulatory, and government affairs matters

• Prepare reports, recommendations, presentations, and executive communications regarding payer and government-relations initiatives

• Educate internal stakeholders on current and anticipated payer, legislative, and regulatory developments

• Gather and analyze data to support payer negotiations, advocacy initiatives, policy positions, and strategic decision-making

• Translate complex policy, regulatory, reimbursement, and contractual information into clear recommendations for different audiences

• Partner cross-functionally with Legal, Revenue Cycle, Finance, Operations, Clinical Services, and other teams

• Identify emerging risks and opportunities and proactively recommend strategies to leadership

• Represent PHS professionally and effectively with external stakeholders, industry partners, and public officials

• Exercise sound judgment and discretion when managing confidential and sensitive matters

WHAT WE'RE LOOKING FOR:

• Bachelor's degree required; Master's degree in Healthcare Administration, Business Administration, Finance, or related field preferred.
• 10+ years of progressive leadership experience in payer relations, managed care contracting, or healthcare revenue cycle.
• Demonstrated success negotiating competitive reimbursement rates ad complex contract structures.
• Experience developing national payer relationships and executing multi-market contracting strategies.
• Deep understanding of reimbursement methodologies, regulatory requirements, and healthcare financial operations.
• Proven ability to structure innovative payment arrangements aligned with clinical outcomes and service complexity.
• Strong analytical skills, negotiation skills, executive presence, and ability to influence senior payer leadership.

PREFERRED QUALIFICATIONS:

• Government affairs, legislative advocacy, regulatory affairs, or healthcare public policy experience
• Experience monitoring and analyzing proposed legislation, regulatory changes, and healthcare policy and assessing potential organizational impact
• Experience building relationships with legislators, government agencies, health plans, trade associations, coalitions, and advocacy organizations
• Experience representing an organization before policymakers, government agencies, industry associations, or other external stakeholders
• Experience partnering with Revenue Cycle, Finance, Legal, and operational teams to resolve complex reimbursement, denial, authorization, contractual, or payer issues
• Experience working across multiple states and navigating different payer, Medicaid, legislative, and regulatory environments
• Experience within home health, DME, pediatric healthcare, specialty pharmacy, infusion, private duty nursing, or other home- and community-based healthcare services
• Experience using financial, reimbursement, utilization, clinical, or operational data to support payer negotiations and advocacy initiatives
• Experience developing or supporting alternative, value-based, or other innovative payment arrangements
• Experience educating executive leadership and internal stakeholders on payer, legislative, regulatory, and reimbursement developments
• Master's degree in Public Policy, Public Administration, Healthcare Administration, Business Administration, Finance, or a related field

BENEFITS

• Generous Paid Time Off (PTO) for full time employees to ensure a healthy work-life balance
• 401(k) Matching to help secure your future
• Tuition Reimbursement to support your educational and professional growth
• Professional Development & Learning Opportunities to expand your skills and knowledge in pediatric care
• Health and Dental insurance
• Short & Long Term Disability and Life Insurance

Interested candidates should apply online at http://www.phscareers.com.

We look forward to learning more about you & the skills you can bring to Pediatric Home Service!

Pediatric Home Service is an equal opportunity employer; we are committed to affirmative action and equal employment opportunities for all regardless of protected veteran status, race, color, creed, religion, national origin, sex, sexual orientation or identity, disability, age, marital status, familial status, membership or activity in a local human rights commission, or status with regard to public assistance. #DME123