Health Plan Network Strategy Director
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Job Location:
Albuquerque, NM - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
HJ Staffing is seeking a Health Plan Network Strategy Director to spearhead strategic initiatives in provider contracting network development and adequacy. This executive-level role is responsible for building high-value partnerships with major provider organizations and managing a contract portfolio exceeding $1B annually. You will serve as the architect of our network strategy ensuring federal and state compliance while optimizing cost coverage and market growth.
What You Will Do
- Strategic Contracting: Lead negotiations for high-value provider contracts with major hospital systems; own complex contract modeling and network adequacy technologies.
- Performance Oversight: Oversee contract performance audits and remediation strategies collaborating with Actuarial Finance and Medical Economics teams.
- Network Adequacy: Monitor and ensure compliance with federal and state regulations proactively identifying and closing access gaps.
- Market Expansion: Lead due diligence for network development in expansion markets and identify opportunities for optimization.
- Financial Stewardship: Align negotiated rates with budgeted medical cost trends and support forecasting for unit cost increases.
- Data-Driven Strategy: Analyze claims data and market dynamics to guide contract negotiations and enhance cost-of-care strategies.
- Relationship Management: Build and maintain executive-level relationships with integrated delivery systems and provider organizations.
What You Will Bring
- Experience: 10 years of combined experience in managed care provider contracting network operations and health plan operations.
- Education: Bachelors degree in Business Healthcare Administration or a related field (Masters Degree preferred).
- Industry Expertise: Direct experience within a Health Plan or Managed Care Organization is required.
- Technical Proficiency: Experience with Jiva and HRP is a significant plus.
- Subject Matter Expertise: Deep knowledge of reimbursement methodologies including fee-for-service risk sharing and capitation.
You Will Be Successful If:
- You are a master of financial analytics with the business acumen to manage complex multi-market environments.
- You possess elite communication skills and are comfortable with public speaking and executive presentations.
- You stay at the forefront of national healthcare policies and emerging care delivery models.
- You can navigate and influence large integrated delivery systems and joint ventures effectively.
Important Details
- Residency Requirement: Candidates must reside in one of the following states: NM CA IL ND NY OH WA or WY.
- Remote Status: This position is 100% remote.
- Citizenship: Candidates must be a US Citizen or Green Card holder.
Required Experience:
Director
Key Skills
- Business Development
- Marketing
- Pricing
- Analysis Skills
- Research Experience
- Project Management
- Research & Development
- Strategic Planning
- Financial Modeling
- Leadership Experience
- Management Consulting
- Analytics
About Company
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