Health Plan Network Strategy Director

Job Description: • 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. Benefits: • 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. Apply tot his job