Strategic Director, Provider Network Performance

Search Results; United States; Hybrid; USD 150,000 - 230,000; Full time

Job summary

Search Results is seeking a Director, Provider Network Performance & Engagement to lead strategies optimizing provider networks, value-based contracting, and provider relationships. Hybrid role based in Michigan with onsite presence required two days weekly.

The ideal candidate will have 10+ years in healthcare strategy or network management, strong leadership, and expertise in VBP, HEDIS/CAHPS/NCQA/URAC standards, and cross-functional collaboration with quality and analytics teams.

Qualifications

• Bachelor's degree required.
• 5+ years of provider contracting experience.
• 10+ years of healthcare strategy, provider relations, or network management.
• Managed care experience preferred.

Responsibilities

• Lead initiatives to monitor and improve provider performance, focusing on quality, efficiency, cost of care, and patient outcomes.
• Develop and execute annual provider network strategy including network adequacy standards and value-based strategies.
• Analyze utilization and financial data to identify cost drivers and implement interventions.
• Oversee VBP negotiations, VBP contract performance, and related strategies with internal stakeholders.
• Monitor SCA and out-of-network utilization and trends; develop contracting strategies to increase in-network utilization.
• Provide staffing supervision and conduct annual reviews; manage performance issues.
• Ensure compliance with federal and state rules, regulations, policies, and procedures; update department policies as needed.
• Establish KPIs and report network performance to executives.
• Partner with Market Director of Quality on HEDIS/CAHPS/NCQA/URAC and analytics alignment.
• Oversee network adequacy monitoring and gap closure strategies across Plan territory.
• Manage large-scale provider terminations with tracking, reporting, and risk mitigation.
• Ensure contracts align with guidelines, payment methodologies, and regulatory requirements.
• Lead complex negotiations for facilities and value-based contracts for clinically integrated networks.
• Other duties as assigned.

Skills

Provider network mgmt

Provider contracting

Reimbursement methods

Value-based payments

Analytical skills

Quality standards

Leadership

Staff supervision

Cross-functional collab

Education

Bachelor's degree

Job description

Search Results is seeking a Director, Provider Network Performance & Engagement to lead strategies optimizing provider networks, value-based contracting, and provider relationships. Hybrid role based in Michigan with onsite presence required two days weekly.

The ideal candidate will have 10+ years in healthcare strategy or network management, strong leadership, and expertise in VBP, HEDIS/CAHPS/NCQA/URAC standards, and cross-functional collaboration with quality and analytics teams.