Health Plan Network Strategy Director

HJ Staffing is seeking a Health Plan Network Strategy Director to spearhead strategic initiatives in provider contracting, network development, and adequacy. This executive-level role is responsible for building high-value partnerships with major provider organizations and managing a contract portfolio exceeding $1B annually. You will serve as the architect of our network strategy, ensuring federal and state compliance while optimizing cost, coverage, and market growth.

What You Will Do

• Strategic Contracting: Lead negotiations for high-value provider contracts with major hospital systems; own complex contract modeling and network adequacy technologies.
• Performance Oversight: Oversee contract performance audits and remediation strategies, collaborating with Actuarial, Finance, and Medical Economics teams.
• Network Adequacy: Monitor and ensure compliance with federal and state regulations, proactively identifying and closing access gaps.
• Market Expansion: Lead due diligence for network development in expansion markets and identify opportunities for optimization.
• Financial Stewardship: Align negotiated rates with budgeted medical cost trends and support forecasting for unit cost increases.
• Data-Driven Strategy: Analyze claims data and market dynamics to guide contract negotiations and enhance "cost-of-care" strategies.
• Relationship Management: Build and maintain executive-level relationships with integrated delivery systems and provider organizations.

What You Will Bring

• Experience: 10 years of combined experience in managed care, provider contracting, network operations, and health plan operations.
• Education: Bachelor’s degree in Business, Healthcare Administration, or a related field (Master’s Degree preferred).
• Industry Expertise: Direct experience within a Health Plan or Managed Care Organization is required.
• Technical Proficiency: Experience with Jiva and HRP is a significant plus.
• Subject Matter Expertise: Deep knowledge of reimbursement methodologies, including fee-for-service, risk sharing, and capitation.

You Will Be Successful If:

• You are a master of financial analytics with the business acumen to manage complex, multi-market environments.
• You possess elite communication skills and are comfortable with public speaking and executive presentations.
• You stay at the forefront of national healthcare policies and emerging care delivery models.
• You can navigate and influence large integrated delivery systems and joint ventures effectively.

Important Details

• Residency Requirement: Candidates must reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY.
• Remote Status: This position is 100% remote.
• Citizenship: Candidates must be a US Citizen or Green Card holder.