Director, Network Contracting

The Director of Contracting is responsible for contract strategy, development, negotiation, and implementation for hospitals, physician groups, and integrated delivery systems across multiple markets and products. The Director will lead a team who negotiates contracts including risk arrangements to enable high performing provider networks that support goals for membership growth, quality, and financial performance. The Director will foster and maintain strong relationships with strategic providers to support achievement of shared plan and provider objectives. The Director is member of the leadership team and will be actively engaged in division strategy, planning and performance initiatives. This role will manage a team of contract managers and will work in a matrix environment collaborating with functions including risk adjustment, population health, finance, operations, actuarial, and sales.

Job Description

Key Responsibilities/Duties:

Provider Network Strategy and Development

• Develop provider networks to meet goals for access, membership, quality, medical cost, and earnings. Build and maintain high performing provider networks utilizing risk-based structures and incentives whenever possible. Identify and recommend changes to networks as needed to advance business goals.
• Collaborate with VP and President to develop network strategies, risk sharing and payment models, and performance incentives to support achievement of cost and quality goals.
• Stay abreast of trends and changes in the industry, provider landscape, and federal and state payment policies and methodologies. Utilize this knowledge to refine and advance network development and performance.

Contract Negotiation and Management

• Direct a team of contract managers to negotiate financial, operational, regulatory, and legal contract parameters with physician groups, ACOs, and hospitals to meet business goals and regulatory timelines.
• Coach, support, and train staff to devise proposals, strategies, and options for contract negotiation. Support contract negotiation as needed.
• Devise strategy, lead and negotiate agreements with largest provider systems.
• Develop and maintain optimal provider networks. Assess, monitor, and manage network adequacy to meet federal and state regulations. Proactively identify and close network gaps.
• Collaborate with Enterprise Allied Health Contracting to ensure allied health and BH/SA networks and payment terms support Medicare division needs and goals. Assess and monitor allied payment rates and recommend changes to methodology and rates to align incentives and manage expense trends.
• Collaborate with colleagues in the Enterprise Network Operations to ensure timely and accurate contract implementation, configuration, and accurate ongoing contract administration.

Strategic Relationship Management

• Develop and implement a proactive relationship management approach that supports long-term, mutually successful relationships with strategic providers.
• Engage with the provider performance team to understand and monitor provider and network performance. Advise on performance improvement plans and identify contract strategies and incentives that support performance improvement.
• Collaborate with operations, professional relations, and other functions to identify and resolve provider issues.

Stakeholder Engagement

• Proactively communicate and engage with function leaders and key stakeholders. Participate in/chair leadership meetings concerning provider strategy, network development and other issues.

Talent Management and Team Building

• Provide ongoing staff development and coaching in negotiation, performance analysis, and relationship management to enable a high-performing team of provider professionals.
• Other duties and projects as assigned.

Experience:

• Required (minimum): 10-15 years of progressively responsible management experience in a complex healthcare setting. Experience in managed care contracting and experience working collaboratively with providers.
• Preferred: 10-15 years of Medicare Advantage experience.

Skill Requirements:

• Energetic, goal driven leader with a proven ability to deliver results and lead teams to achieve goals.
• Strong working knowledge of managed care/risk contracting payment methodologies.
• Savvy negotiator with experience in a range of provider payment methodologies including risk. Demonstrated experience in direct, high-level negotiations with the proven ability to close a deal while maintaining relationships.
• Excellent quantitative skills with ability to synthesize financial information, create and evaluate options.
• Excellent interpersonal skills and a high level of diplomacy to anticipate, recognize and deal effectively with complex issues.
• Strong relationship skills to influence and work collaboratively with physicians and other provider leaders.
• Excellent management skills to guide, inspire and develop a high performing team.
• Ability to manage and direct multiple priorities across markets while meeting aggressive deadlines.
• Adaptable to change and ambiguous situations; able to maintain constructive behavior in challenging situations. Requires the ability to think and plan strategically. Ability to assess and address interests of the enterprise and providers
• Strong collaborator able to work effectively across functions.

Working Conditions:

• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.