Director, Provider Network & Contracting

The Squires Group•Washington, DC

3d•$180,000•Hybrid

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
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

Nice To Haves

Master’s degree in Business or Healthcare Administration preferred

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.