Director of Contracting

BrightSpring Health Services; Cleveland (OH); Sur place; USD 130 000 - 150 000; Plein temps

Résumé du poste

BrightSpring Health Services in Cleveland, OH seeks a Director of Contracting to lead provider contracts and network management across markets. You will design network strategies, negotiate terms, and drive value-based initiatives with finance and compliance partners.

The role demands strategic leadership, strong negotiation skills, and experience in managed care contracting, with responsibility for budgets, analytics, and cross-functional collaboration.

Qualifications

• At least 5 years of experience in managed care, health plan operations, provider contracting, or network management.
• Proven progress from operational to strategic leadership roles.
• Prior experience negotiating complex provider contracts (hospital systems, physician groups, ancillary providers).
• Experience with value-based contracting, risk sharing, capitation, bundled payments, shared savings, etc.
• Demonstrated ability to manage and develop teams.

Responsabilités

• Develop, lead and execute provider network strategies to ensure access across geographies and specialties.
• Negotiate contracts with hospitals, physician groups, ancillary providers, and facility partners.
• Manage contract lifecycle: drafting, reviewing, executing, renewing, amending, termination.
• Structure payment models including fee-for-service, capitation, bundled payments, shared savings.
• Oversee provider data integrity, delegation oversight, and provider performance.
• Coordinate with legal, finance, compliance, claims, and member services.
• Lead operational functions such as network administration and provider directory maintenance.
• Monitor regulatory compliance and ensure alignment with quality and cost targets.

Connaissances

Network design

Contract negotiations

Team leadership

Provider relations

Formation

Bachelor's degree

Description du poste

Director of Contracting

Job Locations: US-KY-LOUISVILLE | US-OH-CLEVELAND | US-TN-NASHVILLE | US-TX-DALLAS

Position Type: Full-Time

Salary Range: USD $130,000.00 - $150,000.00 / Year

Overview

The Dir of Contracting & Network Management is a leadership role responsible for developing, negotiating, and managing provider contracts and networks for the health plan. This leader ensures that provider networks are adequate, efficient, financially sustainable, and aligned with the organization's strategic goals (e.g., value-based care, member access, cost containment). The role combines strategy, operations, regulatory compliance, provider relationships, analytics, and financial oversight.

Responsibilities

Key Responsibilities

• Network Strategy & Design
  • Develop, lead and execute provider network strategies to ensure sufficient access across specialties and geographies.
  • Evaluate market trends, competitor networks, member needs, and regulatory requirements.
  • Identify network adequacy gaps (geographic, specialty, quality) and develop plans to close them.
• Contracting & Negotiations
  • Negotiate contracts with hospitals, physician groups, ancillary providers, and facility partners.
  • Manage contract lifecycle: drafting, reviewing, executing, renewing, amending, termination.
  • Structure payment/reimbursement models, including fee-for-service, capitation, bundled payments, shared savings, etc.
  • Ensure terms in contracts align with financial targets, risk tolerances, quality goals, and regulatory obligations.
• Provider Relations & Network Management
  • Maintain and strengthen relationships with providers; serve as point of escalation for issues.
  • Oversee provider data integrity, delegation oversight, and provider performance.
  • Facilitate provider satisfaction, addressing service or payment concerns.
  • Support provider onboarding, education around contract terms, and performance expectations.
• Operational Oversight & Compliance
  • Lead operational functions such as network administration, provider directory maintenance, delegation oversight.
  • Ensure network adequacy meets federal/state regulatory requirements.
  • Oversee policies, procedures, and systems to track and govern contracting and network operations.
  • Coordinate with legal, finance, compliance, claims, member services, and other stakeholders.
• Value-Based Care & Cost Management
  • Lead or support the development of value-based contracting models
  • Work with analytics team to develop monitoring for utilization, cost trends, provider performance, and identify improvement opportunities.
  • Develop reimbursement strategies that balance cost, access, quality, and provider incentives.
• Financial Management & Analytics
  • Develop and manage budgets for network and contracting functions.
  • Forecast network costs, provider reimbursements; assess financial impacts of different contracting strategies.
  • Monitor medical loss ratio (MLR) and other cost drivers associated with provider contracts.
• Leadership & Team Management
  • Build, lead, mentor, and manage a high performing team spanning contracting, provider relations, network operations, and other cross functional teams for implementation.
  • Set goals, provide feedback, drive accountability.
  • Foster a culture of collaboration, continuous improvement, and responsiveness.
• Stakeholder Engagement & Internal Collaboration
  • Serve on senior leadership teams; align network & contracting strategy with organizational objectives.
  • Collaborate with product development, sales, marketing to ensure network adequacy supports product offerings.
  • Coordinate with utilization management, quality, member services, clinical, legal, and regulatory affairs.
• Regulatory & Industry Monitoring
  • Stay current on relevant state and federal regulations (e.g., network adequacy, reimbursement law)
  • Monitor trends in managed care, payer/provider innovations, competitive market shifts.
  • Adapt strategies to evolving regulatory requirements and market conditions.

Qualifications

Bachelor's degree preferred or related years of contracting and leadership experience

Experience:

• At least 5 years of experience in managed care, health plan operations, provider contracting, or network management.
• Proven progress from operational to strategic leadership roles.
• Prior experience negotiating complex provider contracts (hospital systems, physician groups, ancillary providers).
• Experience with value-based contracting, risk sharing, capitation, bundled payments, shared savings, etc.
• Demonstrated ability to manage and develop teams.

Skills & Knowledge:

• Strong financial acumen; ability to model cost/reimbursement scenarios.
• Excellent negotiation, communication, and relationship building skills.
• Ability to use data/analytics to drive decision making.
• Knowledge of regulatory requirements (state/federal), accreditation standards, network adequacy requirements.
• Change management, strategy implementation, cross-functional leadership.

About our Line of Business

Abilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year-round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet each member's clinical needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com. Follow us on LinkedIn.

Salary Range

USD $130,000.00 - $150,000.00 / Year