Director - Provider Contracting (Capitation Specialist)
About The Position
We are currently seeking a highly motivated Senior Director – Provider Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Alhambra, CA and Monterey Park, CA and at home on a weekly basis. This role will work closely with the VP of Contracting to develop and execute on managed care capitated specialist contracting strategies and negotiations. You will be responsible for identifying and evaluating specialist capitation provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.
Requirements
- Master’s degree and/or Bachelor’s degree (BS/BA) in business administration or a health care related field, or equivalent experience
- At least 10 years of prior experience in capitation contracting with Specialists.
- Ability to analyze complex financial data, contracts, and regulatory documents with accuracy and insight.
- Strong problem-solving skills and a strategic, methodical approach to delivering sustainable solutions.
- Highly organized, detail-focused, and effective at leading teams through thorough investigations with ambiguous or incomplete information.
- Clear communication, verbally and in writing, and ability to translate technical and contractual language into practical recommendations for executives and stakeholders.
- Deep knowledge of delegated network operations and regulatory requirements, including overseeing compliance in complex healthcare settings.
- Highly proficient in Microsoft Excel, Word, and PowerPoint, using them for strategic presentations, contract modeling, and executive reporting.
- Understanding of EZ-Cap and other proprietary healthcare administration systems and ability to lead teams that use these platforms effectively.
Responsibilities
- Own and manage capitated specialist relationships with senior leadership, serving as the escalation point for critical issues and long-term partnership development.
- Design and oversee contracting strategies aligned with organizational goals for growth, compliance, and cost-effectiveness.
- Act as a thought leader, providing executive-level guidance on contracting initiatives.
- Direct and ensure proper administration of Division of Financial Responsibility (DOFRs), contract amendments, and RFPs.
- Oversee project management of all specialist capitation contracting initiatives, ensuring timely, compliant execution.
- Interpret and assess contractual risk in provider agreements, leading high-stakes, time-sensitive negotiations.
- Ensure contracts optimize reimbursement, protect the organizations' interests, and strengthen provider relationships.
- Establish and maintain policies and processes that streamline contract review, approval, and execution across the enterprise.
- Partner with Claims, Configuration, Business Development, and Data Management to align operations with contracting strategies.
- Drive root-cause solutions to systemic issues affecting contract performance or compliance.
- Provide executive-level reports and recommendations to senior leadership on network adequacy, financial impact, and strategic opportunities related to specialist capitation agreements.
- Other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
