Health Plan Strategy Lead

Abby Care is scaling fast, expanding into new state markets and growing from our core programs into new verticals and payor partnership models. Our Health Plan Strategy team reports directly to Abby Care’s CEO. We own the company’s payor partnership strategy and the execution and infrastructure that makes those partnerships successful. We're looking for a Health Plan Strategy Lead to join the team. Reporting to the Head of Health Plan Strategy., you'll be the primary architect behind our new payor partnerships, including the research, design, and market strategy for new state markets, new clinical verticals, and new innovation opportunities.

Your focus is upfront rigor: building the models and regulatory maps that justify entering a new state, launching a new vertical, or standing up a new care model, developing growth strategy and market intelligence to guide where we go next, setting KPIs, defining clinical and economic outcomes, and establishing the blueprint for payor pilots. We need someone who's energized by tackling the unknown, charting a path where none exists yet, and turning ambiguity into an opportunity we can execute on.

A true strategic architect, you are excited to evaluate the strategic considerations and incentives of individual payors in a market, and use that context to inform Abby Care’s entry strategy. You excel at digging into complex research, state regulations, and financial mechanics to design rock-solid programs and market-entry plans. You have a builder mentality and are eager to jump into a high growth environment . High level of ownership defines your work - you take accountability for the market-expansion strategy and program design decisions, that drive our success, and own the research and economic modeling required to make those decisions with high rigor. You demonstrate comfort in ambiguity, and effortlessly synthesize complex healthcare data and policy into actionable strategy across multiple states and verticals simultaneously. If you are excited by the opportunity to shape the next phase of growth in a highly collaborative and cross functional environment, we would love to hear from you!

This is a Full-Time position based in our San Francisco office (4-days-a-week).

• Own the strategic business case for entering new state markets, sizing opportunity, mapping the competitive and payor landscape, and defining a state-specific entry strategy

• Build the playbook that turns "should we enter this market or vertical" into a structured, repeatable process as Abby Care scales into new states

• Identify and evaluate adjacent verticals and populations where Abby Care's care model can extend, and build the initial business case and program parameters for each

• Partner closely with the Head of Health Plan Strategy to define, structure, and document core design parameters, value propositions, and pilot architecture for home health payor initiatives across existing and new verticals

• Establish the quantitative foundation for programs: model program economics, set target clinical and operational KPIs, and define the ROI frameworks presented to health plans

• Conduct deep market and operational research to guide the strategic positioning, parameter design, and structural rollout

• Deeply research state-specific healthcare regulations, Medicaid waivers, licensing requirements, and payor mandates to ensure all proposed program and market designs are fully compliant and aligned with state-specific payor incentive models

• Work hand-in-hand with Legal and Compliance and Clinical leaders to solidify program parameters, then package and hand off finalized blueprints to Program Managers for operational execution

• Participate in strategic payor meetings alongside leadership, synthesizing payor priorities and feedback into actionable program and market-entry adjustments

• As the strategy function's scope grows with new markets and verticals, grow a team supporting research, modeling, and program design

• Set the standards and processes for how the team conducts market research, builds economic models, and packages strategic recommendations for executive and payor audiences
  

• 5+ years of professional experience, with a strong preference for experience at a top-tier management consulting firm

• Deep understanding of healthcare payor landscapes, state Medicaid regulatory frameworks, home health models, and consumer-directed program structures and experience researching relevant regulations, state-by-state rules, and compliance requirements

• Proven track record designing programs from scratch, including understanding regulatory/stakeholder needs, defining value proposition, establishing clinical and financial metrics, and evaluating what’s necessary for a pilot vs. full scale; ability to combine quantitative and qualitative analyses and own the resulting business case

• Highly structured thinker who excels at crisp documentation, operational frameworks, and handoff packages for execution teams

• Experience managing or mentoring team members, or clear readiness to build and lead a team as scope expands