Associate Director of Provider Network and Contracting

Associate Director of Provider Network and Contracting
South Country Health Alliance

South Country Health Alliance is seeking an Associate Director of Provider Network and Contracting to join our team! In this role you will provide operational direction and leadership to South Countrys Provider Contracting and Provider Relations teams to secure and maintain competitive contractual relationships with providers in accordance with regulatory operational and financial goals and standards and ensure South Countrys adherence with network management goals state federal and other regulatory requirements.

What Youll Bring:

• Bachelors degree (Health Care Administration or business-related field)
• 5 years experience in a health care delivery setting
• 3 years experience in contract and pricing management in health care
• A knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products
• Direct contracting and negotiation experience with providers.

Why South Country

South Country Health Alliance is more than a health planwere a mission-driven organization dedicated to improving health and well-being in rural Minnesota communities. Our work is guided by values of communication collaboration stewardship and excellence ensuring that every employee contributes to making a real difference in peoples lives.

We invest in our team with:

• Comprehensive benefits: Medical dental vision life insurance short- and long-term disability pension (PERA) and more.
• Work-life flexibility: Hybrid and remote options with quarterly on-site expectations.
• Predictable pay growth: Structured step-based salary system for transparency and salary range for this position is between $117000 and $139713/ year.

Join us and be part of an organization that values community impact employee well-being and innovation.

Must be legally authorized to work in the U.S. (No sponsorship available)

Associate Director of Provider Network and Contracting

Department: Provider Network and Contracting
Reports To: Compliance Officer
Pay Grade: 14
Supervises: 4
Revision Date: December 2025

JOB SUMMARY:

This position is responsible for providing operational direction and leadership to South Countrys Provider Contracting and Provider Relations teams to secure and maintain competitive contractual relationships with providers in accordance with regulatory operational and financial goals and standards and ensure South Countrys adherence with network management goals state federal and other regulatory requirements.

QUALIFICATIONS:

: Bachelors degree in a health care or business-related field or other relevant field; (5) Five years experience in health care delivery setting (e.g. hospital health insurance HMO or community service provider physician group practice) (3) Three years experience in contract and pricing management in health care; Knowledge of both State Public Programs (MN Medicaid) and Medicare (dual) products; Direct contracting and negotiation experience with providers.

Preferred: Knowledge of and experience with provider credentialing and related processes

Skill Sets: Outstanding oral written and interpersonal communication skills; demonstrated leadership ability; exceptional conflict and problem resolution skills; strong organization skills; proficient in providing high-level customer service; strong financial analysis skills and ability to analyze data and processes and apply them to network development and contracting; self-starter and ability to take initiative; excellent presentation skills; well-developed project management and negotiation skills.

ESSENTIAL DUTIES and RESPONSIBILITIES:

The duties and responsibilities listed below reflect the general details necessary to describe the essential functions of the position and shall not be construed as the only duties that may be assigned for the position.

% of Total Time

1. Coach mentor and manage a team of professionals to achieve favorable and timely contract terms build and strengthen relationships with key providers and support South Countrys strategic provider-related goals. 20%
2. Lead develop and implement South Countrys provider network contracting activities and responding to access and availability enhancement goals. Bring provider market intelligence and insights to key internal provider forums to inform direction and decisions. 20%
3. Along with the Compliance Officer and the CFO negotiate contractual relationships with providers that support SCHAs strategic financial operational and program-specific goals utilizing an appropriate reimbursement methodology consistent with network strategy and contracting goals. Ability to work with outside consulting actuaries on structure and financial modeling of programs. 20%
4. Develop an annual contract renewal and negotiation plan in collaboration with teams and other internal stakeholders. Report status quarterly to South Country leadership and key committees. 10%
5. Maintain a working knowledge of State of MN and CMS provider reimbursement methodologies and other relevant strategies and ensure this information is presented to South Country operational areas as may be relevant to support South Countrys policies and strategies. 10%
6. Develop and maintain network oversight plans by provider/network type. Ensure contractual regulatory and NCQA compliance for network providers. 10%
7. Support program management efforts related to unique Medicare and Medicaid networks. Ensure departmental staff members align work efforts with enterprise-wide goals and objectives for these networks/services. 5%
8. Work effectively with South Countrys Compliance Officer CFO leadership program managers operations staff and selected third party administrators to ensure that the South Country provider contracts are understood and interpreted (for system implementation) for accurate administration. 5%
9. Other duties assigned within the scope responsibility and requirements of the job.

QUALIFICATION REQUIREMENT

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able and willing to travel regionally is support of job responsibilities.

LANGUAGE SKILLS

Strong listening verbal presentation and written communication skills; Advanced language skills including inquiry skills to assure clear issue identification; Ability to articulate complex issues effectively to a variety of audiences; Writing is clear and to the point; Chooses the appropriate method of communication to meet customer and organizational needs. Must be able to read and write in English.

MATHMATICAL SKILLS

Advanced mathematical skills. Intermediate to advanced data analysis and financial modeling skills. Ability to calculate and forecast pricing methodologies.

ACCURACY

High attention to detail and considerable accuracy is required of this position; Errors and omissions would be difficult to detect and could result in overpayment of medical expenses and the inability of members to access health care services and in contractual and regulatory non-compliance. These errors could have a critical impact on members or SCHAs relationship with business partners.

REASONING ABILITY

Must utilize keen judgment and highly developed analytical skills in balancing complex business issues in the decision-making and strategy-setting process.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is regularly required to talk or hear. The employee frequently is required to sit sometimes for extended periods of time. The employee is occasionally required to stand; walk; use hands to finger handle or feel objects tools or controls; and reach with hands and arms.

The employee would rarely lift and/or move up to 5 pounds. Specific vision abilities required by this job include close vision distance vision peripheral vision depth perception and the ability to adjust focus.

CONTACTS/RELATIONSHIPS

This position requires extensive contact and influence with multiple key business partners including providers outside actuaries TPAs and DHS staff to achieve desired business results. This position may present new methods or procedures to improve current practices or meet changing conditions and is considered a technical expert in this field.

FINANCIAL IMPACT

This position has considerable impact in influencing the medical expense budget (over $190 million) for South Country and involves considerable responsibility for the expenditure of large sums of money.

The mental and physical requirements described here are representative of those that must be met by an individual to successfully perform the essential functions of this position.