Health Plan Network Strategy Director

Role Overview

• 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.