Health Plan Network Strategy Director
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Job Description
Health Plan Network Strategy Director managing provider contracts and ensuring compliance across major market. Building partnerships and optimizing healthcare networks for efficiency and cost.
Responsibilities:
- Lead negotiations for high-value provider contracts with major hospital systems; own complex contract modeling and network adequacy technologies.
- Oversee contract performance audits and remediation strategies, collaborating with Actuarial, Finance, and Medical Economics teams.
- Monitor and ensure compliance with federal and state regulations, proactively identifying and closing access gaps.
- Lead due diligence for network development in expansion markets and identify opportunities for optimization.
- Align negotiated rates with budgeted medical cost trends and support forecasting for unit cost increases.
- Analyze claims data and market dynamics to guide contract negotiations and enhance "cost-of-care" strategies.
- Build and maintain executive-level relationships with integrated delivery systems and provider organizations.
Requirements:
- 10+ years of combined experience in managed care, provider contracting, network operations, and health plan operations.
- Bachelor’s degree in Business, Healthcare Administration, or a related field (Master’s Degree preferred).
- Direct experience within a Health Plan or Managed Care Organization is required.
- Experience with Jiva and HRP is a significant plus.
- Deep knowledge of reimbursement methodologies, including fee-for-service, risk sharing, and capitation.
Benefits:
- Candidates must reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY.
- Remote Status: This position is 100% remote.
- Citizenship: Candidates must be a US Citizen or Green Card holder.
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