Strategic Network Contracting Leader

CareMore Health; California; In loco; USD 130.000 - 195.000; Tempo pieno

Descrizione del lavoro

CareMore Health in the United States seeks a Network Contracting Lead, a senior individual contributor who excels in provider contracting, developing and negotiating complex provider agreements to support the care delivery model and value-based care initiatives. You will lead negotiations with physicians, hospitals, and other providers while ensuring regulatory compliance and network adequacy.

You will partner with Finance, Legal, Clinical Leadership, Provider Relations, Market Operations, and

Mansioni

• Lead complex provider contract negotiations involving physician groups, specialists, hospitals, ancillary providers, health systems, and other healthcare partners supporting CareMore's care delivery network.
• Develop and execute contracting strategies that support CareMore's clinical model, patient access requirements, network adequacy, financial objectives, and market-specific needs.
• Independently evaluate and negotiate reimbursement terms, contract structures, performance requirements, and value-based arrangements to ensure competitive and sustainable provider partnerships.
• Manage complex contract renewals, amendments, terminations, and renegotiations while minimizing disruption to patient care and provider relationships.
• Partner with CareMore's market and clinical leadership to evaluate provider network needs, identify service gaps, and develop contracting solutions that improve patient access and continuity of care.
• Support the development and optimization of provider networks aligned with CareMore's coordinated, patient-centered care delivery model.
• Evaluate provider performance, market competitiveness, reimbursement trends, and network adequacy to identify opportunities for network improvement and cost optimization.
• Provide strategic contracting recommendations that support market growth, operational effectiveness, and the long-term sustainability of CareMore's provider network.
• Develop and negotiate provider agreements that support value-based care, quality improvement, cost management, and coordinated care delivery.
• Evaluate reimbursement methodologies, including fee-for-service, capitation, shared savings, risk-based arrangements, and other alternative payment models, as applicable.
• Partner with Finance and Clinical Leadership to assess the financial and operational implications of proposed contracting arrangements.
• Support contracting strategies that promote appropriate utilization, improved clinical outcomes, and effective management of total cost of care.
• Serve as a primary contracting advisor to CareMore's senior leadership, providing expertise on complex negotiations, reimbursement strategies, provider economics, and network development.
• Collaborate with Finance, Legal, Clinical Operations, Provider Relations, Credentialing, and Market Leadership to resolve complex contracting and provider-related issues.
• Present contracting recommendations, financial analyses, negotiation strategies, and identified risks to senior leadership to support informed business decisions.

Descrizione del lavoro

CareMore Health in the United States seeks a Network Contracting Lead, a senior individual contributor who excels in provider contracting, developing and negotiating complex provider agreements to support the care delivery model and value-based care initiatives. You will lead negotiations with physicians, hospitals, and other providers while ensuring regulatory compliance and network adequacy.

You will partner with Finance, Legal, Clinical Leadership, Provider Relations, Market Operations, and