How You Will Contribute
Provider Contracting Strategy & Negotiation
- Lead development and execution of provider contracting strategies across markets and provider types, balancing cost, access, quality, network competitiveness, and long-term sustainability.
- Lead and support complex, high-impact negotiations with health systems and other provider partners, including contract renewals, reimbursement arrangements, amendments, new market opportunities, and escalated contractual issues.
- Develop negotiation strategies, objectives, financial parameters, and trade-off scenarios using market intelligence, contract performance, utilization trends, and organizational priorities.
- Evaluate reimbursement methodologies and contract terms, including fee schedules, percent-of-charge arrangements, case rates, bundled arrangements, value-based models, and other alternative payment structures.
- Identify contractual, financial, operational, and relationship risks; develop recommendations and escalation strategies to support informed decision-making.
- Ensure executed agreements and negotiated terms are clearly documented, operationally feasible, and effectively transitioned to the teams responsible for implementation and ongoing administration.
Provider Relationships & Network Performance
- Build and maintain productive, long-term relationships with provider executives, contracting leaders, and operational partners through transparency, credibility, and consistent follow-through.
- Serve as a senior point of escalation for complex provider relationship matters, balancing partnership objectives with The Alliance’s responsibility to employers and members.
- Monitor provider and contract performance using cost, utilization, access, market, and other available data; identify opportunities for renegotiation, intervention, or strategic development.
- Assess network gaps, provider opportunities, and market dynamics and recommend strategies that strengthen access, affordability, differentiation, and competitive position.
- Partner with providers to resolve systemic issues and improve the effectiveness of the provider relationship and member experience.
Leadership & Team Development
- Lead, coach, and develop provider contracting and relations team members; establish clear expectations, decision rights, priorities, and accountability for results.
- Build team capability in negotiation, relationship management, reimbursement strategy, market analysis, project execution, and effective cross-functional partnership.
- Create scalable workflows, standards, documentation, and operating rhythms that support consistent contracting practices and effective management of the provider portfolio.
- Allocate team resources and priorities based on organizational strategy, market needs, contract cycles, and emerging provider opportunities or risks.
- Foster a collaborative, accountable, learning-oriented culture that supports sound judgment, continuous improvement, and strong internal and external relationships.
Cross-Functional Strategy & Organizational Partnership
- Partner closely with Provider Relations leadership and colleagues across Analytics, Finance, Legal, Operations, Business Development/Employer Engagement, and other functions to develop and execute integrated provider strategies.
- Translate employer needs, market feedback, financial analysis, and network performance insights into actionable contracting and provider relationship priorities.
- Provide provider-market expertise and recommendations in organizational planning, product development, growth initiatives, and strategic decision-making.
- Communicate complex contracting issues, market dynamics, risks, and recommendations clearly to executive and senior leadership audiences.
- Ensure key stakeholders are appropriately engaged throughout contracting initiatives and understand decisions, dependencies, implementation requirements, and expected outcomes.
Market Intelligence, Innovation & Growth
- Maintain a strong understanding of healthcare market trends, provider consolidation, reimbursement practices, regulatory developments, transparency requirements, and emerging payment and delivery models.
- Analyze external developments and competitive dynamics to anticipate potential impacts on The Alliance’s provider network and employer members.
- Identify and evaluate opportunities for new provider partnerships, market expansion, alternative contracting approaches, and solutions that improve healthcare value.
- Develop data-informed business cases and recommendations for contracting initiatives, provider strategies, and network investments.
Operational Excellence, Projects & Vendor Oversight
- Lead complex provider-facing projects and contracting initiatives from strategy and planning through negotiation, implementation, and transition to ongoing ownership.
- Establish project objectives, milestones, stakeholder roles, decision points, risks, and communication expectations for major contracting initiatives.
- Evaluate and oversee vendors or external partners supporting contracting, network operations, data, or provider-facing work; monitor service, value, and performance.
- Champion effective use of systems, data, templates, tools, and process improvements that increase contracting discipline, visibility, efficiency, and scalability.
- Maintain appropriate documentation and support compliance with organizational policies, contractual obligations, and applicable regulatory requirements.