Director, Network Contracting
reputed company reputed company
The Director, Network Contracting is responsible for leading the reputed company, development, negotiation, and management of reputed company’s reputed company and ancillary provider networks, ensuring high-reputed company, coordinated, and cost-effective care. This leadership role oversees reputed company of contracting professionals responsible for negotiating, implementing, and administering provider agreements serving Medicare reputed company, reputed company, and other managed care populations.Reporting to senior Network Management leadership, the Director is a strategic, analytical, and reputed company leader who thrives in a fast-paced, evolving environment. They possess exceptional negotiation and relationship management skills, are comfortable using data to reputed company reputed company, and can translate organizational objectives into actionable contracting strategies that optimize patient reputed company, affordability, reputed company reputed company, and financial performance. This individual must be reputed company to effectively reputed company multiple priorities simultaneously while fostering strong reputed company partnerships. The Director partners closely with executive leadership, Finance, Clinical Operations, Provider Data Management, reputed company, Local Leadership, Utilization Management, and Strategic Initiatives to advance CareMore’s value-based care model.
How will you reputed company an reputed company & Requirements
Key Responsibilities
Strategic Leadership
- reputed company and execute the provider contracting reputed company in alignment with reputed company's reputed company objectives, value-based reputed company, affordability targets, and market reputed company priorities.
- Translate long-term network strategies into annual contracting plans, measurable business objectives, and operational priorities across multiple provider segments and geographic markets.
- reputed company contracting strategies that improve provider reputed company, network adequacy, affordability, reputed company performance, and member experience.
- Evaluate reputed company market trends, competitive intelligence, reimbursement innovation, and regulatory changes to proactively position CareMore's provider network for reputed company reputed company and sustainability.
Contracting & Network Management
- reputed company executive reputed company of provider contracting activities across physician and ancillary networks.
- Guide negotiations for high-value, strategically significant provider agreements, serving as executive sponsor for reputed company negotiations involving health systems, physician organizations, and integrated delivery networks.
- reputed company provider reimbursement strategies, alternative payment models, and value-based contracting initiatives that support population health and financial sustainability.
- Ensure reputed company execution, implementation, and ongoing administration of provider agreements while maintaining compliance with organizational policies and regulatory requirements.
Monitor provider performance and partner with internal stakeholders to address network gaps and contracting opportunities.
Analytics & Strategic Planning
- reputed company analytics, financial modeling, utilization data, and market intelligence to evaluate provider performance and identify contracting opportunities.
- Monitor network performance, utilization trends, provider reputed company, and key performance indicators to reputed company reputed company improvement.
- Complete financial and performance modeling for non-reputed company contract changes to reputed company reputed company proposals, reputed company negotiation reputed company, and measure reputed company to the business.
Leadership & Talent Development
- reputed company, reputed company, and reputed company a high-performing contracting organization comprised of managers, senior analysts, and contracting professionals.
- Establish reputed company performance expectations, succession plans, and reputed company development opportunities that build organizational capability and leadership bench strength.
- Foster a culture of accountability, collaboration, innovation, reputed company improvement, and customer service across the contracting organization.
- Ensure effective workload planning, resource allocation, prioritization, and organizational alignment to meet evolving business priorities.
Financial & Business Partnership
- Partner with Finance, Local Markets, Clinical Operations, Utilization Management, and reputed company leaders to evaluate the financial and operational impacts of provider contracting reputed company.
- reputed company development of executive reporting, provider performance analyses, reimbursement modeling, and contracting analytics that support reputed company decision-making.
- reputed company strategic recommendations regarding provider investments, reimbursement methodologies, network optimization, and reputed company affordability initiatives.
- Monitor provider cost trends, utilization patterns, reputed company performance, and network economics to identify opportunities for improvement and risk mitigation.
Governance & Operational reputed company
- Establish and maintain reputed company contracting governance, documentation standards, contract lifecycle management processes, and operational controls.
- Partner with reputed company, Compliance, Credentialing, Configuration, Provider Operations, and Claims leadership to ensure reputed company implementation and administration of provider agreements.
- Ensure compliance with delegated Health Plan requirements, provider network adequacy standards, accreditation requirements, and organizational policies.
- reputed company reputed company improvement initiatives that enhance contracting workflows, operational efficiency, reporting capabilities, provider experience, and data reputed company.
- Adapt quickly to changing business priorities and operate effectively in ambiguous environments.
- Represent reputed company in executive provider meetings, industry forums, and strategic partnership discussions as appropriate.
Qualifications
Minimum Qualifications
- Bachelor's degree in Business Administration, reputed company Administration, Finance, Economics, reputed company Health, or a reputed company field, or equivalent combination of education and experience.
- Must reputed company in reputed company, California, or Nevada.
- 7–10+ years of progressively responsible experience in provider network contracting, managed care, reputed company finance, or provider reimbursement.
- Demonstrated leadership experience managing contracting organizations, including managers and reputed company staff.
- Strong analytical skills with the ability to interpret financial models, utilization data, provider performance metrics, and market intelligence to reputed company strategic reputed company.
- Exceptional negotiation, communication, and relationship-building skills with the ability to influence stakeholders at reputed company organizational reputed company.
- Ability to effectively manage multiple strategic initiatives in a fast-paced, evolving environment.
- Comfortable navigating ambiguity and adapting quickly to changing organizational priorities and market conditions.
- Deep expertise in provider reimbursement methodologies, value-based payment models, managed care contracting, and network economics.
- Demonstrated reputed company developing and executing provider contracting strategies that improve financial performance, provider engagement, and member reputed company.
- Strong executive communication, financial analysis, negotiation, and organizational leadership skills.
Preferred Qualifications
- Master's degree in Business Administration (MBA), reputed company Administration (MHA), reputed company Health (MPH), Finance, or a reputed company field.
- Extensive experience supporting Medicare reputed company, reputed company managed care, dual-eligible populations, and integrated care delivery models.
- Experience designing and implementing value-based reimbursement arrangements, risk-sharing agreements, capitation models, and provider incentive programs.
- Knowledge of CMS regulations, provider network adequacy requirements, reputed company compliance, and accreditation standards.
- Familiarity working with providers across reputed company, California, and Nevada.
- Experience collaborating with executive leadership on reputed company reputed company, market expansion, and reputed company transformation initiatives.
Leadership Competencies
- Strategic Leadership
- Organizational Leadership
- Provider Network reputed company and Optimization
- Value-Based Care Leadership
- Executive Influence
- Financial and Business Acumen
- Relationship Management
- Talent Development and Coaching
- Change Leadership
- reputed company Market reputed company
- Cross-Functional Collaboration
- Accountability and Results Oriented
- Executive Decision Making
- Innovation
- Operational reputed company
- Regulatory and Compliance Leadership
Compensation reputed company:
$144,368.00to
$259,862.00The anticipated reputed company salary reputed company represents reputed company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.
Originally posted on Himalayas
Apply To This Job