Network Contracting Director

verawholehealth; United States; On-site; USD 180,000 - 260,000; Full time

Job summary

CareMore Health seeks a Network Contracting Director to lead strategy, development, negotiation, and management of professional and ancillary provider networks for Medicare Advantage, Medicaid, and other managed care populations.

The role partners with executive leadership and cross-functional teams to optimize access, affordability, quality outcomes, and financial performance while steering multiple priorities and maintaining regulatory compliance.

Qualifications

• Experience leading provider contracting in healthcare (Medicare/Managed Care) preferred.
• Ability to translate organizational goals into contracting strategies.
• Strong negotiation, analytics, and relationship management skills.

Responsibilities

• Develop and execute the provider contracting strategy in alignment with enterprise objectives.
• Oversee contracting activities across physician and ancillary networks.
• Guide negotiations for high-value provider agreements with health systems and IDNs.
• Monitor network performance and address gaps and opportunities.
• Lead analytics and financial modeling for contract changes and rate proposals.
• Foster leadership and talent development within the contracting organization.

Skills

Negotiation

Strategic leadership

Data analytics

Stakeholder management

Team leadership

Job description

Job Description Summary

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

Reporting to senior Network Management leadership, the Director is a strategic, analytical, and collaborative leader who thrives in a fast-paced, evolving environment. They possess exceptional negotiation and relationship management skills, are comfortable using data to drive decisions, and can translate organizational objectives into actionable contracting strategies that optimize patient access, affordability, quality outcomes, and financial performance. This individual must be able to effectively lead multiple priorities simultaneously while fostering strong internal and external partnerships. The Director partners closely with executive leadership, Finance, Clinical Operations, Provider Data Management, Legal, Local Leadership, Utilization Management, and Strategic Initiatives to advance CareMore's value-based care model.

Key Responsibilities:

Strategic Leadership

Develop and execute the provider 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 provider access, network adequacy, affordability, quality performance, and member experience.

Evaluate healthcare market trends, competitive intelligence, reimbursement innovation, and regulatory changes to proactively position CareMore's provider network for future growth and sustainability.

Contracting & Network Management

Provide executive oversight of provider contracting activities across physician and ancillary networks.

Guide negotiations for high-value, strategically significant provider agreements, serving as executive sponsor for complex negotiations involving health systems, physician organizations, and integrated delivery networks.

Oversee provider reimbursement strategies, alternative payment models, and value-based contracting initiatives that support population health and financial sustainability.

Ensure timely execution, implementation, and ongoing administration of provider agreements while maintaining compliance with organizational policies and regulatory requirements.

Monitor provider performance and partner with internal stakeholders to address network gaps and contracting opportunities.

Analytics & Strategic Planning

Leverage analytics, financial modeling, utilization data, and market intelligence to evaluate provider performance and identify contracting opportunities.

Monitor network performance, utilization trends, provider access, and key performance indicators to drive continuous improvement.

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 comprised of managers, senior analysts, and 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 provider contracting decisions.

Oversee development of executive reporting, provider performance analyses, reimbursement modeling, and contracting analytics that support enterprise decision-making.

Provide strategic recommendations regarding provider investments, reimbursement methodologies, network optimization, and healthcare affordability initiatives.

Monitor provider 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.