Network Contracting Director

CareMore Health Management Services, LLC; California; Hybrid; USD 157,000 - 236,000; Full time

Job summary

CareMore Health Management Services, LLC is seeking a Director of Network Contracting to lead hospital and ancillary contracting strategy, cost management, and provider negotiations across Medicare Advantage, Medicaid and other managed care programs. You will oversee a small team and drive value-based contracting initiatives.

This role requires strategic leadership, governance, analytics, and cross-functional partnership with Finance, Clinical Operations, and Strategy.

Qualifications

• Develop and execute hospital and ancillary contracting strategy aligned with enterprise objectives and market priorities.
• Lead contracting negotiations for high-value, strategically significant agreements.
• Oversee reimbursement strategies and value-based contracting initiatives.
• Lead and develop a high-performing contracting team with clear objectives and growth opportunities.
• Establish governance, standards, and controls for contract lifecycle management.

Responsibilities

• Provide executive oversight of hospital and ancillary contracting activities across networks.
• Negotiate and implement agreements that optimize access, cost, and quality.
• Utilize analytics and financial modeling to evaluate performance and inform rate proposals.
• Collaborate with Finance, Local Markets, Clinical Operations and Strategy to drive business impact.

Job description

The Director, Network Contracting is responsible for leading the strategy, development, medical expense management, and oversight of CareMore Health’s hospital and ancillary provider networks, ensuring high-quality, coordinated, and cost-effective care. This leadership role oversees a small team of contracting professionals responsible for negotiating, implementing, and administering agreements serving Medicare Advantage, Medicaid, and other managed care populations.

How will you make an impact & Requirements

Strategic Leadership Develop and execute the hospital and ancillary contracting strategy in alignment with CareMore Health's enterprise objectives, value-based care initiatives, affordability targets, and market growth priorities. Translate long-term network strategies into annual contracting plans, measurable business objectives, and operational priorities across multiple provider segments and geographic markets. Lead contracting strategies that improve access, satisfy network adequacy, affordability, quality performance, and member experience. Evaluate healthcare market trends, competitive intelligence, reimbursement innovation, and regulatory changes to proactively position CareMore's hospital and ancillary network for future growth and sustainability. Contracting & Network Management Provide executive oversight of contracting activities across hospital and ancillary networks. Guide negotiations for high-value, strategically significant agreements, serving as executive sponsor for complex negotiations. Oversee reimbursement strategies, alternative payment models, and value-based contracting initiatives that support improved patient outcomes and financial sustainability. Ensure timely execution, implementation, and ongoing administration of hospital and ancillary agreements while maintaining compliance with organizational policies and regulatory requirements. Monitor contract performance and partner with internal stakeholders to address network gaps and contracting opportunities while controlling medical expense and meaningfully reducing the cost of care. Analytics & Strategic Planning Leverage analytics, financial modeling, utilization data, and market intelligence to evaluate performance and identify contracting opportunities. Complete financial and performance modeling for non-complex contract changes to develop rate proposals, form negotiation strategy, and measure impact to the business. Leadership & Talent Development Lead, coach, and develop a high-performing contracting organization of contracting professionals. Establish clear performance expectations, succession plans, and professional development opportunities that build organizational capability and leadership bench strength. Foster a culture of accountability, collaboration, innovation, continuous improvement, and customer service across the contracting organization. Ensure effective workload planning, resource allocation, prioritization, and organizational alignment to meet evolving business priorities. Financial & Business Partnership Partner with Finance, Local Markets, Clinical Operations, Utilization Management, and Strategy leaders to evaluate the financial and operational impacts of contracting decisions. Oversee development of executive reporting, performance analyses, reimbursement modeling, and contracting analytics that support enterprise decision-making. Provide strategic recommendations regarding reimbursement methodologies, network optimization, and healthcare affordability initiatives. Monitor cost trends, utilization patterns, quality performance, and network economics to identify opportunities for improvement and risk mitigation. Governance & Operational Excellence Establish and maintain enterprise contracting governance, documentation standards, contract lifecycle management processes, and operational controls. Partner with Legal, Compliance, Credentialing, Configuration, Provider Operations, and Claims leadership to ensure seamless implementation and administration of agreements. Ensure compliance with delegated Health Plan requirements, network adequacy standards, accreditation requirements, and organizational policies. Lead continuous improvement initiatives that enhance contracting workflows, operational efficiency, reporting capabilities, and data integrity. Adapt quickly to changing business priorities and operate effectively in ambiguous environments. Represent CareMore Health in executive provider meetings, industry forums, and strategic partnership discussions as appropriate.

Compensation Range: $157,492.00 to $236,238.00 The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.