Senior Network Contracting Lead Value-Based Care

CareMore Health; Sacramento (CA); On-site; USD 98,000 - 147,000; Full time

Job summary

CareMore Health, a leading provider of Medicare Advantage, Medicaid, and other managed care services, seeks a Senior Network Contracting Analyst to lead complex provider agreements and strategic contracting initiatives. You will analyze financial models, negotiate terms, and collaborate across Finance, Legal, Compliance, and Clinical leadership to optimize network performance.

The role focuses on managing contracts from strategy through implementation, developing reimbursement strategies, and

Responsibilities

• Lead negotiations for complex primary care and specialty provider agreements, managing the full contract lifecycle from strategy development through execution and implementation.
• Develop negotiation strategies by evaluating provider performance, reimbursement methodologies, market conditions, utilization trends, quality metrics, and competitive intelligence.
• Interpret complex financial models to assess reimbursement scenarios, contract economics, provider performance, and the financial impact of proposed contract terms.
• Structure provider agreements that balance medical expense and affordability initiatives, network adequacy, quality outcomes, regulatory compliance, and long-term provider partnerships.
• Collaborate with Finance, Legal, Compliance, Provider Operations, Configuration, Credentialing, and Clinical leadership to ensure accurate implementation and operational readiness of executed agreements.
• Analyze provider network adequacy, access standards, cost trends, utilization patterns, and market opportunities to recommend strategic contracting initiatives and network optimization strategies.
• Serve as the primary contracting contact for assigned provider organizations, resolving contract interpretation questions, reimbursement issues, and operational concerns while fostering collaborative provider relationships.
• Support the development and implementation of value-based payment arrangements, including shared savings, quality incentive, bundled payment, capitation, and other alternative reimbursement models.
• Identify contracting risks and opportunities, recommending solutions that improve provider performance, member access, quality outcomes, and financial sustainability.
• Lead cross-functional contracting projects and process improvement initiatives that enhance operational efficiency, contract governance, and data integrity.
• Prepare executive-level reports, financial analyses, and contracting recommendations for Network Management leadership.
• Stay current on CMS regulations, state Medicaid requirements, healthcare market trends, and industry best practices that impact provider contracting and reimbursement.
• Foster a sense of curiosity and desire to understand how various provider relationships interact with overall CareMore strategic initiatives.
• Pivot quickly and prioritize workload in line with changing organizational objectives.

Job description

CareMore Health, a leading provider of Medicare Advantage, Medicaid, and other managed care services, seeks a Senior Network Contracting Analyst to lead complex provider agreements and strategic contracting initiatives. You will analyze financial models, negotiate terms, and collaborate across Finance, Legal, Compliance, and Clinical leadership to optimize network performance.

The role focuses on managing contracts from strategy through implementation, developing reimbursement strategies, and