AVP - Provider Strategy & Contracting

Overview

The AVP, Provider Strategy and Contracting is a strategic leadership role responsible for overseeing the development, negotiation, execution, and ongoing management of provider contracts across CareCentrix’s network.

This role leads provider partnerships, contracting strategy, rate negotiations, adequacy, and performance optimization to support multiple product lines, including durable medical equipment, home infusion therapy, sleep management, and traditional home health.

 

In this role you will develop and implement scalable contracting models and network strategies to build high-performing provider networks. This includes oversight of contract lifecycle management, negotiation frameworks, provider rate setting, and value-based or performance-driven arrangements where applicable. The role partners cross-functionally to enhance network capabilities, ensure adequate provider coverage to meet patient needs, strengthen provider engagement, and drive operational excellence across the provider lifecycle—from contracting and onboarding through performance management and renewal.

 

You will partner cross-functionally to enhance network capabilities, ensure adequate provider coverage to meet patient needs, strengthen provider engagement, and drive operational excellence across the provider lifecycle—from contracting and onboarding through performance management and renewal.

Responsibilities

Network Strategy & Adequacy

• Lead the development and execution of enterprise-wide provider network and contacting strategies to ensure network adequacy, competitive positioning, and alignment with business growth objectives
• Define and drive multi-year provider contracting roadmaps, including rate strategy, value-based care models, and risk-sharing arrangements
• Oversee network design, expansion, and optimization across markets, ensuring alignment to cost-of-care targets, access standards, and product strategy
• Utilize market intelligence, competitive insights, and performance analytics to inform network composition and contracting priorities
• Ensure network configurations balance cost efficiency, quality outcomes, and provider access including optimization of high performing and preferred provider tiers

Provider Network Development, Contracting & Operations

• Direct end-to-end provider network development, including contracting strategy, negotiation execution, reimbursement methodologies, and ongoing performance management
• Establish and implement innovative contracting models (e.g. value-based care, bundled payments, shared savings, capitation where appropriate) to drive cost, quality, and experience outcomes
• Lead complex provider negotiations with health systems, specialty providers, and ancillary partners, ensuring alignment with financial targets and strategic priorities
• Identify and executive opportunities to strengthen network performance through contract optimization, utilization management alignment, and provider incentives
• Oversee network capacity planning, coverage adequacy, and provider mix optimization to meet demand and growth projections
• Drive enhancements to provider-facing tools, systems, and processes to improve operational efficiency and experience
• Ensure all network initiatives and contracting programs delivery against defined KPIs, including affordability, unit cost reductions, ROI and performance guarantees

Program Product & Contracting Alignment

• Partner with Product, Clinical, and Market leaders to align network capabilities with product design and clinical program requirements
• Ensure provider contracts and reimbursement structures support new product features, care models and clinical program requirements
• Enable scalable network and contracting solutions to support new market entry, product launches, and client-specific configurations
• Lead the development of network-related program capabilities and positioning to support client growth and retention

Pipeline, Growth & Innovation

• Partner closely Sales, Underwriting, Medical Economics, and Actuarial teams to align network contracting strategy with pricing, underwriting assumptions and growth targetsSupport pre-sale and post-sale activities through network strategy articulation, provider disruption analysis, and competitive positioningEnsure timely adaptation of network models in response to evolving healthcare landscape and client needs

Cross-Functional Leadership

• Serve as a key liaison between Network Management, Product / Network Analytics, Medical Economics, Provider Experience, Clinical Operations, Compliance, Revenue Cycle Management (RCM), Implementations