Health Plan Network Strategy Director
Presbyterian Healthcare ServicesAlbuquerque, NM, USjob_description.job_card.variable_days_ago
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job_description.job_card.job_descriptionMaster's degree preferred Minimum of 15 years of combined experience in managed care, provider contracting, network operations, and health plan management Bachelors degree or equivalent experience in Business Administration, Healthcare Administration or related field. Masters Degree Preferred. 15+ years of combined experience in managed care, provider contracting, provider network operations and management, and health plan operations experience. Knowledgeable of the full continuum of reimbursement methodologies to include fee-for-service, risk sharing, and capitation Must possess strong communication skills and be comfortable with public speaking. Excellent financial and analytics as well as business acumen and familiarity with the operations of sophisticated large integrated delivery systems, innovative business models, managing of a complex multi-institutional and multi-market environment, joint ventures, and evolving population health and payment models. Knowledge of current national health care policies and trends, as well as leadership, management, and quality improvement concepts. Leading the development and negotiation of high-value provider contractsexceeding $1B annuallywith major hospital systems and provider organizations. Owning complex contract modeling and network adequacy technologies, ensuring alignment with strategic goals. Overseeing provider contract performance audits and remediation strategies in collaboration with actuarial, finance, medical economics, claims operations, and payment integrity teams. Monitoring network adequacy and ensuring compliance with federal and state regulations, while identifying and addressing access gaps. Conducting ongoing analysis of provider networks from cost, coverage, and growth perspectives to inform strategic expansion decisions. Leading provider contract due diligence for network development in expansion markets. Serving as a subject matter expert on reimbursement methodologies and educating key operational teams. Supporting budgeting and forecasting efforts related to medical trend and unit cost increases. Driving contract performance by aligning negotiated rates with budgeted medical cost trends. Analyzing claims data and market dynamics to guide strategic contract negotiations. Building and maintaining executive-level relationships with provider organizations. Collaborating with Presbyterian System leaders to grow accretive market share and enhance the value of the health plan through innovative cost-of-care strategies. Staying abreast of industry trends, regulatory changes, and emerging care delivery models to continuously refine network strategy.
Health Plan Network Strategy Director
Presbyterian is seeking a Health Plan Network Strategy Director to lead strategic initiatives in provider contracting, network development, and adequacy. This role is responsible for building and maintaining high-level partnerships with provider organizations, ensuring compliance with federal and state regulations, and supporting access and availability standards. The strategist will conduct ongoing cost, coverage, and growth analyses of the provider network and identify opportunities for expansion or optimization to align with health plan goals.
We're determined to take care of those working in healthcare.
Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.
Why Join Us
- Full Time - Exempt : Yes
- Job is based at Rev Hugh Cooper Admin Center
- Work hours : Weekday Schedule Monday-Friday
- Benefits : We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
Ideal Candidate Profile :
Qualifications
Responsibilities
Benefits
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.
The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift cards and other incentives.
AA / EOE / VET / DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses.
Maximum Offer for this position is up to
USD $91.73 / Hr.
Compensation Disclaimer
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
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