Provider Network Management Director

Anticipated End Date:

2025-11-17

Position Title:

Provider Network Management Director

Job Description:

Provider Network Management Director

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Travels to worksite and other locations as necessary.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Provider Network Management Director is responsible for developing and managing the provider network through strategic contract negotiations, relationship development, and servicing for large health systems and affiliated physician groups, including employed, hospital-based, and hospital-owned ancillary providers. The primary focus of this role is contracting and negotiating complex terms with the most intricate health systems and affiliated providers, supporting value-based initiatives. This individual will bring comprehensive experience across all lines of business—including Medicare, Medicaid, and commercial and will have skill not only in contracting but also solid understanding of claims, pricing, and system configuration. The ideal candidate must possess contracting and negotiation experience involving $25 million or more. Additionally, they should have experience with executive presentations, possess a higher level of coordination, and be able to effectively engage with executive leadership, demonstrating seasoned executive presence.

How you will make an impact:

• Serves in a leadership capacity, leading associate resources, special projects/initiatives, or network planning.

• Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit.

• Typically serves as lead contractor for large scale, multi-faceted negotiations.

• Serves as business unit representative on enterprise initiatives around network management and leads projects with significant impact.

• May assist management in network development planning.

• May provide work direction and establish priorities for field staff and may be involved in associate development and mentoring.

• Contracts involve non-standard arrangements that require a high level of negotiation skills.

• Fee schedules are customized.

• Works independently and requires high level of judgment and discretion.

• May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management.

• May collaborate with sales team in making presentations to employer groups.

• Serves as a communication link between providers and the company.

• Conducts the most complex negotiations.

• Prepares financial projections and conducts analysis.

Minimum Requirements:

Requires a BA/BS degree and a minimum of 8 years’ experience in contracting (value based, shared savings and ACO development), provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experience:

• Experience in healthcare contracting, with direct skill in negotiating with large providers and service vendors, strongly preferred.

• Proven track record of successfully negotiating and managing provider contracts, with a comprehensive understanding of industry standards, billing codes, reimbursement mechanisms, and the regulatory landscape, strongly preferred.

• Deep knowledge of Medicare, Medicaid, and Commercial business practices, strongly preferred.

• Proven ability to negotiate complex contracts with payers, securing favorable terms for the organization, preferred.

• Experience using financial models and analysis to negotiate rates with providers strongly preferred.

• Exceptional strategic thinking, decision-making, problem-solving skills, and adaptability highly preferred.

• Experience interacting confidently with senior management and executive level stakeholders, as a subject matter expert and comforta