JOB SUMMARY
The Senior Director of Managed Care Contracting and Network Strategy serves as a key leader in the development, negotiation, and execution of provider contracting strategies across all lines of business, with emphasis on Hospitals, Ambulatory Surgery Centers, Ancillary, Multi-Specialty Groups, and Anesthesia. This position is responsible for driving network growth, optimizing reimbursement methodologies, and ensuring that provider partnerships support the organization’s mission, financial goals, and regulatory requirements. This role functions as the strategic lead for provider contracting, network development, and network strategy; collaborating closely with
executive leadership, finance, compliance, legal, and operations to ensure the health plan’s network is competitive, sustainable, and aligned with access and value-based care initiatives.

Essential Functions
-Strategic Leadership: Develop and implement comprehensive contracting strategies that advance the organization’s financial and network adequacy objectives.
-Contract Negotiation and Management: Lead the negotiation and execution of hospital, physician, ancillary, and specialty provider agreements; ensure fair reimbursement rates, compliance with regulations, and alignment with plan performance goals.
-Network Development & Optimization: Direct network expansion initiatives in underserved areas; evaluate network performance, gaps, and opportunities to strengthen provider partnerships and member access.
-Value-Based and Alternative Payment Models: Partner with actuarial and clinical teams to design, negotiate, and monitor value-based arrangements and incentive programs that drive quality and affordability. Identifies and manages cost issues and implements appropriate cost saving initiatives and/or settlements.
-Cross-Functional Collaboration: Work closely with Finance, Compliance, Provider Relations, and Credentialing to ensure contracting and network activities are fully integrated and communicated across departments.
-Governance and Reporting: Prepare executive-level analyses and presentations for the CEO, CFO, and Board on contracting performance, network adequacy, and rate trends.
-Stakeholder Engagement: Act as a key liaison with high-value providers, health systems, and community partners to maintain strong, transparent relationships and resolve contracting issues efficiently.
-Market Intelligence: Monitor trends in reimbursement methodologies, payer-provider relations, and regulatory changes (TDI, CMS, etc.) to inform contract strategy and compliance.

MINIMUM EDUCATION:

Bachelors Degree (higher degree accepted) in Business, Healthcare Administration, Finance, or related field 

REQUIRED EXPERIENCE:

7 years of progressive experience in managed care contracting, network management, or provider relations, including 2+ years in a leadership role

PREFERRED EXPERIENCE:

Health Plan Experience

Experience in government-sponsored programs (Medicaid, Marketplace, or Medicare Advantage)