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Health Plan Network Strategy Director
Location
United States
Posted
72 days ago
Salary
0
Seniority
Lead
No structured requirement data.
Job Description
Health Plan Network Strategy Director
HJ Staffing
Role Description 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. - 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. Qualifications - 10+ years of combined experience in managed care, provider contracting, network operations, and health plan operations. - Bachelor's degree in Business, Healthcare Administration, or a related field (Master's Degree preferred). - Direct experience within a Health Plan or Managed Care Organization is required. - Experience with Jiva and HRP is a significant plus. - Deep knowledge of reimbursement methodologies, including fee-for-service, risk sharing, and capitation. Requirements - 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.
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