Director, Provider Network & Contracting

The Squires Group • Washington, DC

86d • $180,000 - $180,000

About The Position

Our client, a leading health plan in the District of Columbia, is seeking an experienced Director, Provider Network & Contracting to oversee value-based care (VBC) strategies, provider contracting, and network development. This is a key leadership role responsible for supervising a team of four, negotiating provider reimbursement and incentive-based arrangements, and ensuring the growth of a high-quality, cost-efficient provider network. The position requires Green Card Holder or U.S. Citizenship. Candidates must be able to work onsite in Washington, DC four days per week (one day remote). A comprehensive background check (employment, education, drug screening) is required. Employees must also provide proof of flu vaccination, unless an exemption is submitted.

Requirements

• Bachelor’s degree in a related field required.
• 8–10 years of experience in managed care/healthcare, with strong provider contracting and network development expertise.
• 5–7 years of experience with government programs, specifically Medicaid and Medicare.
• Hands-on experience with provider pay-for-performance programs and value-based care reimbursement models.
• Significant experience managing provider networks (primary care and specialty) with focus on access to care.
• 5–7 years of supervisory experience, including direct staff leadership and team development.
• Strong knowledge of APR-DRG hospital reimbursement methodology and claims adjudication systems.

Nice To Haves

• Master’s degree in Business or Healthcare Administration preferred.
• Exceptional negotiation, problem-solving, and decision-making skills.
• Strong financial acumen with proven contracting and data analysis experience.
• Ability to manage multiple projects and priorities effectively.
• Excellent written and verbal communication skills, including formal presentations.
• Proficiency with MS Office (Word, Excel, PowerPoint) and database applications.
• Demonstrated ability to build collaborative provider relationships to support quality and financial initiatives.
• Knowledge of state and federal regulatory requirements, with broad experience in both commercial and government healthcare contracting.

Responsibilities

• Lead network development, provider recruitment, contracting, and retention initiatives to ensure access to quality, cost-efficient care.
• Negotiate provider reimbursement rates, contract terms, and alternative payment methodologies (e.g., shared savings, risk sharing, bundled arrangements).
• Direct the Provider Relations team, including daily operations, hiring, performance evaluations, mentoring, and professional development.
• Develop and oversee value-based care arrangements and provider pay-for-performance programs.
• Collaborate with finance, operations, and legal teams to manage all financial, operational, and compliance aspects of provider contracts.
• Ensure compliance with all state and federal regulatory requirements, including Medicaid and Medicare standards.
• Oversee the development and implementation of provider education programs and initiatives to strengthen provider engagement.
• Monitor cost containment initiatives and implement strategies to meet strategic goals.
• Provide leadership and guidance on complex reimbursement and contracting issues, including APR-DRG hospital reimbursement methodology and claims adjudication.
• Assess market readiness for network expansion and development in targeted states.

Benefits

• Salary up to $180K (no bonus).
• Relocation support may be available depending on compensation needs.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Bachelor's degree
• Number of Employees: 51-100 employees