Health Plan Network Strategy Director

Presbyterian Healthcare Services

29d • $121,846 - $190,798

About The Position

Build your Career. Make a Difference. Presbyterian is hiring a skilled Health Plan Network Strategy Director to join our team.
Presbyterian is seeking a Health Plan Network Strategy Director to lead strategic initiatives in provider contracting, network development, and adequacy. This role is responsible for building and maintaining high-level partnerships with provider organizations, ensuring compliance with federal and state regulations, and supporting access and availability standards. The strategist will conduct ongoing cost, coverage, and growth analyses of the provider network and identify opportunities for expansion or optimization to align with health plan goals.
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses. Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
Here, we’re committed to a different way to make a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans. We are part of New Mexico's history and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

Requirements

• Bachelors degree or equivalent experience in Business Administration, Healthcare Administration or related field.
• 10 years of combined experience in managed care, provider contracting, provider network operations and management, and health plan operations experience.
• Knowledgeable of the full continuum of reimbursement methodologies to include fee-for-service, risk sharing, and capitation
• Must possess strong communication skills and be comfortable with public speaking.
• Excellent financial and analytics as well as business acumen and familiarity with the operations of sophisticated large integrated delivery systems, innovative business models, managing of a complex multi-institutional and multi-market environment, joint ventures, and evolving population health and payment models.
• Knowledge of current national health care policies and trends, as well as leadership, management, and quality improvement concepts.

Nice To Haves

• Masters Degree Preferred.

Responsibilities

• Leading the development and negotiation of high-value provider contracts—exceeding $1B annually—with major hospital systems and provider organizations.
• Owning complex contract modeling and network adequacy technologies, ensuring alignment with strategic goals.
• Overseeing provider contract performance audits and remediation strategies in collaboration with actuarial, finance, medical economics, claims operations, and payment integrity teams.
• Monitoring network adequacy and ensuring compliance with federal and state regulations, while identifying and addressing access gaps.
• Conducting ongoing analysis of provider networks from cost, coverage, and growth perspectives to inform strategic expansion decisions.
• Leading provider contract due diligence for network development in expansion markets.

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees