Director, Provider Contracting- Work from home

Luminare Health Benefits Inc.; Nashville (TN); Remote; USD 121,000 - 225,000; Full time

Job summary

Health Care Service Corporation (HCSC) is seeking a senior contracting leader to develop and manage network strategies, draft reimbursement contracts, and oversee contracting operations for commercial and government networks.

You will lead a team, ensure network adequacy, monitor provider compensation programs, and travel as needed to support partnerships across regions. The role emphasizes negotiation, collaboration, and compliance with regulatory and corporate policies.

Qualifications

• Bachelor’s degree plus 5 years’ experience in hospital/health care contracting or hospital/physician relations
• 5 years management experience
• Experience with large integrated health care delivery systems and complex reimbursement strategies
• Experience proactively developing and maintaining relationships with health care provider leadership teams
• Knowledge of outpatient and provider reimbursement strategies and policies
• Experience with financial matters such as contract performance and impact including accuracy and sound judgment
• Negotiation skills
• Leadership skills

Responsibilities

• Develop and manage contracting strategies for operations relative to commercial and government networks.
• Accountable for the development, negotiation, and successful completion of reimbursement contracts. Ensure network adequacy for commercial and government networks.
• Develop network, draft reimbursement agreements, and negotiate reimbursement contracts for hospitals, large professional groups with special pricing, and hospital-based physicians, for commercial and government networks.
• Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
• Develop strategies, draft agreements, and negotiate contracts for newly recognized categories of providers.
• Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed.

Skills

Negotiation

Leadership

Communication

Travel

Team player

Healthcare contracting

Education

Bachelor’s degree

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for the following: the development and management of network strategies, contract drafting, reimbursement contract negotiations, and servicing for hospitals, ancillary, and professional providers for commercial and government networks. This position is responsible for ensuring contracted network coverage and for oversight of staff who manage contracting operations. This position is accountable for the analysis and outcomes of provider compensation programs for commercial and government networks. Ability and willingness to travel.

Job Responsibilities

1. Develop and manage contracting strategies for operations relative to commercial and government networks.
2. Accountable for the development, negotiation, and successful completion of reimbursement contracts. Ensure network adequacy for commercial and government networks.
3. Develop network, draft reimbursement agreements, and negotiate reimbursement contracts for hospitals, large professional groups with special pricing, and hospital-based physicians, for commercial and government networks.
4. Achieve competitive advantage in discounts and access through contract negotiations and effective relationship management.
5. Develop strategies, draft agreements, and negotiate contracts for newly recognized categories of providers.
6. Oversee the analysis and reporting required to develop reimbursement strategies and take corrective action as needed.
7. Accountable for resolution of issues and contractual disputes.
8. Ensure staff meets/exceeds goals, objectives and initiatives. Ensure staff is trained, positions are filled, and employees receive communications on changes, etc.
9. Accountable for budget, operational reporting and financial reporting.
10. Communicate and interact effectively and professionally with co-workers, management, customers, etc.
11. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
12. Maintain complete confidentiality of company related business.
13. Maintain effective communication with leadership within the organization regarding developments within areas of assigned responsibilities and perform special projects as required or requested.

JOB Requirements

• Bachelor’s degree plus 5 years’ experience in hospital/health care contracting or hospital/physician relations
• 5 years management experience
• Experience working with large integrated health care delivery systems and complex reimbursement strategies
• Experience proactively developing and maintaining relationships with health care provider leadership teams with propensity to build trust
• Knowledge of outpatient and provider reimbursement strategies and policies
• Experience with financial matters such as contract performance and impact including accuracy and sound judgment
• Experience proactively developing creative, win-win solutions considering the impact on the provider contract, network, marketability of the product, and profitability of the product
• Negotiation skills
• Leadership skills
• Team player/relationship oriented
• Clear and concise verbal and written communications skills including interpersonal skills, presentation skills to present to executives internally and externally, and team building
• Experience meeting deadlines and work well under pressure
• Experience working across departments to accomplish initiatives and goals, building consensus, driving initiatives, gaining support and developing workable solutions
• Ability and willingness to travel, including overnight stays
• Overseeing the budget and allocating resources for various projects and operational needs.
• Translating needs and initiatives into compelling business cases.
• Conducting cost-benefit analyses to justify investments and ensure ROI.

Preferred Job Requirements

• Bachelor’s degree
• Hospital contracting experience

Please note: This is a Telecommute (Remote) role. Remote employees must live within the continental United States, excluding Alaska, California, Hawaii or New York. Sponsorship is not available.

Pay Transparency Statement

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$121,200.00 - $225,200.00

Exact compensation may vary based on skills, experience, and location.