Director Network Contracting And Provider Strategy
Our client, a leading health plan in the District of Columbia, is seeking an experienced Director Network Contracting and Provider Strategy to oversee value-based care (VBC) strategies, provider contracting, and network development. This is a key leadership role responsible for supervising a team of four, negotiating provider reimbursement and incentive-based arrangements, and ensuring the growth of a high-quality, cost-efficient provider network.
The position requires Green Card Holder or U.S. Citizenship. Candidates must be able to work onsite in Washington, DC four days per week (one day remote). A comprehensive background check (employment, education, drug screening) is required. Employees must also provide proof of flu vaccination, unless an exemption is submitted.
Responsibilities
- Lead network development, provider recruitment, contracting, and retention initiatives to ensure access to quality, cost-efficient care.
- Negotiate provider reimbursement rates, contract terms, and alternative payment methodologies (e.g., shared savings, risk sharing, bundled arrangements).
- Direct the Provider Relations team, including daily operations, hiring, performance evaluations, mentoring, and professional development.
- Develop and oversee value-based care arrangements and provider pay-for-performance programs.
- Collaborate with finance, operations, and legal teams to manage all financial, operational, and compliance aspects of provider contracts.
- Ensure compliance with all state and federal regulatory requirements, including Medicaid and Medicare standards.
- Oversee the development and implementation of provider education programs and initiatives to strengthen provider engagement.
- Monitor cost containment initiatives and implement strategies to meet strategic goals.
- Provide leadership and guidance on complex reimbursement and contracting issues, including APR-DRG hospital reimbursement methodology and claims adjudication.
- Assess market readiness for network expansion and development in targeted states.
Qualifications
Education
Bachelor's degree in a related field requiredMaster's degree in Business or Healthcare Administration preferredExperience
810 years of experience in managed care / healthcare, with strong provider contracting and network development expertise57 years of experience with government programs, specifically Medicaid and MedicareHands-on experience with provider pay-for-performance programs and value-based care reimbursement modelsSignificant experience managing provider networks (primary care and specialty) with focus on access to care57 years of supervisory experience, including direct staff leadership and team developmentStrong knowledge of APR-DRG hospital reimbursement methodology and claims adjudication systemsSkills & Abilities
Exceptional negotiation, problem-solving, and decision-making skillsStrong financial acumen with proven contracting and data analysis experienceAbility to manage multiple projects and priorities effectivelyExcellent written and verbal communication skills, including formal presentationsProficiency with MS Office (Word, Excel, PowerPoint) and database applicationsDemonstrated ability to build collaborative provider relationships to support quality and financial initiativesKnowledge of state and federal regulatory requirements, with broad experience in both commercial and government healthcare contractingThis position offers a salary up to $180K (no bonus) plus benefits. Relocation support may be available depending on compensation needs.