Director, Health Plan Provider Contracting

Technical Summary: The Director, Health Plan Provider Contracting leads the development, negotiation, implementation, and oversight of provider contracts that support the organization's strategic, operational, financial, and regulatory goals. This role manages a team of Contract Managers and Contract Analysts and oversees relationships with hospital health systems, Sub-Acute and ancillary providers. The Director is responsible for developing provider contracting strategies, negotiating and executing complex agreements, reviewing financial analyses, managing provider disputes, and ensuring contract compliance. Working closely with Operations, Finance, Legal, Compliance, Claims, Marketing, and Executive Leadership, this position serves as a key liaison to align provider partnerships with business objectives. The role also oversees contract administration, payment integrity, audits, contract configuration, and initiatives focused on managing external medical costs and improving operational efficiency. Through strong leadership, strategic negotiation, and cross-functional collaboration, the Director ensures high-performing provider networks, effective contract outcomes, and the delivery of high-quality, cost-effective healthcare services.

In addition to the responsibilities listed below, this position is also responsible for driving expectations for the development and/or consultation with the legal team of contract templates and language; championing strong communication techniques when responding to inquiries about contract templates and language; leveraging research on contract rates and services to select best service; setting the direction for the development of rate methodology and strategies; evaluating the network composition against regulatory metrics, health plan client requests, and/or clinical access adequacy needs; driving collaboration efforts with various services lines to develop rate/contract strategies to improve access and availability and service delivery expansion; identifying necessary adjustments to contracting strategy and coordinating operations based on federal and state mandates or regulatory requirements; developing best practices for the negotiation and completion of companion agreements, letters of intent, and/or memoranda of understanding; and developing provider programs in Pay for Performance Agreements, Pay for Quality Agreements, Value Based Purchasing Contracts, and Total Cost of Care.

Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact. Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates