Director, Network Performance and Strategy(Preferred Experience In Managed Care)
About The Position
The Director, Network Performance and Strategy provides strategic leadership for the enterprise Network Performance and Strategy function across markets and lines of business. The role leads the development and execution of network performance management, network optimization, and network strategy capabilities intended to improve affordability, access, quality, provider performance, network competitiveness, and overall plan performance. As a strategic advisor to leadership, the Director translates network performance intelligence into actionable strategies and scalable solutions while respecting market accountability and decision rights. The Director develops standardized network performance frameworks, enterprise reporting and analytics, decision-support tools, and enabling technologies. The role works with Medical Economics, Actuarial, Value-Based Contracting, and Network Contracting leadership to develop and apply performance methodologies, inform provider and contracting strategies, and identify network optimization opportunities. It also oversees deployment of capabilities across markets, manages the team's operating plan and resources, represents the function with executive and cross-functional stakeholders, and establishes accountability for measurable outcomes.
Requirements
- Bachelor's degree in healthcare administration, business, analytics, economics, public health, or a related field; equivalent years of relevant work experience may be accepted in lieu of required education.
- Ten years of progressive experience in managed care, healthcare strategy, network management, provider performance, medical economics, healthcare analytics, or related areas.
- Five years of experience in leadership roles.
- Demonstrated understanding of health-plan network strategy, provider performance, healthcare economics, and managed-care operations.
- Skill in using advanced analytics, AI, or technology-enabled operating models to increase organizational leverage.
- Skill in leading enterprise capabilities across a geographically dispersed health-plan organization.
- Familiarity with operating across multiple markets, business units, or lines of business.
- Strong executive communication, relationship management, and strategic problem-solving skills.
- Skills in enterprise network strategy, network performance management, strategic problem solving, executive leadership, cross-functional influence, market strategy development and analysis, provider performance, change management, data-driven decision making, and organizational leadership.
- No licensure or certification required.
Nice To Haves
- Master's degree, MBA, MHA, MPH, or advanced quantitative degree.
- Experience in Medicaid managed care and/or Medicare Advantage.
- Experience with network optimization, provider performance, value-based care, reimbursement, or medical cost management.
Responsibilities
- Develop standardized frameworks for evaluating provider performance, network adequacy and access, utilization, affordability, leakage and out-of-network utilization, quality, contracting performance, and other network measures.
- Translate network performance intelligence into strategies that improve market performance, affordability, quality, network adequacy, growth, and competitive positioning.
- Advise network leadership using enterprise benchmarks, insights, and scalable solutions.
- Establish enterprise standards and methodologies for consistent network performance management while allowing appropriate market-level flexibility.
- Lead development of enterprise network performance reporting, analytics, decision-support tools, and enabling technologies, including automation, AI, and proprietary platforms.
- Partner with Medical Economics and Actuarial leadership to develop, govern, and apply network performance methodologies and analytical models.
- Partner with Value-Based Contracting leadership to provide network performance intelligence, provider segmentation, performance insights, and strategic recommendations supporting VBC strategy.
- Partner with Network Contracting to translate network intelligence into contracting priorities, provider targeting, reimbursement strategies, and network optimization opportunities.
- Identify and prioritize enterprise network opportunities and develop supporting business cases.
- Oversee deployment of network performance capabilities across markets, driving adoption, change management, and measurable business impact.
- Evaluate emerging technologies, data sources, vendors, and industry practices to strengthen network performance capabilities.
- Develop and manage the team's operating plan, talent strategy, priorities, and resource allocation.
- Represent Network Performance & Strategy with executive leadership and cross-functional stakeholders.
- Establish accountability for measurable outcomes and evaluate the team's impact on network performance and business objectives.
- Perform other job-related duties as requested.
Benefits
- Potential eligibility for a bonus tied to company and individual performance.
- Substantial and comprehensive total rewards package focused on employee well-being.
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What This Job Offers
Job Type
Full-time
Career Level
Director
