Health Plan Network Strategy Director
About The Position
HJ Staffing is seeking a Health Plan Network Strategy Director to spearhead strategic initiatives in provider contracting, network development, and adequacy. This executive-level role is responsible for building high-value partnerships with major provider organizations and managing a contract portfolio exceeding $1B annually . You will serve as the architect of our network strategy, ensuring federal and state compliance while optimizing cost, coverage, and market growth. What You Will Do Strategic Contracting: Lead negotiations for high-value provider contracts with major hospital systems; own complex contract modeling and network adequacy technologies. Performance Oversight: Oversee contract performance audits and remediation strategies, collaborating with Actuarial, Finance, and Medical Economics teams. Network Adequacy: Monitor and ensure compliance with federal and state regulations, proactively identifying and closing access gaps. Market Expansion: Lead due diligence for network development in expansion markets and identify opportunities for optimization. Financial Stewardship: Align negotiated rates with budgeted medical cost trends and support forecasting for unit cost increases. Data-Driven Strategy: Analyze claims data and market dynamics to guide contract negotiations and enhance "cost-of-care" strategies. Relationship Management: Build and maintain executive-level relationships with integrated delivery systems and provider organizations. What You Will Bring Experience: 10+ years of combined experience in managed care, provider contracting, network operations, and health plan operations. Education: Bachelor’s degree in Business, Healthcare Administration, or a related field (Master’s Degree preferred). Industry Expertise: Direct experience within a Health Plan or Managed Care Organization is required. Technical Proficiency: Experience with Jiva and HRP is a significant plus. Subject Matter Expertise: Deep knowledge of reimbursement methodologies, including fee-for-service, risk sharing, and capitation. You Will Be Successful If: You are a master of financial analytics with the business acumen to manage complex, multi-market environments. You possess elite communication skills and are comfortable with public speaking and executive presentations. You stay at the forefront of national healthcare policies and emerging care delivery models. You can navigate and influence large integrated delivery systems and joint ventures effectively. Important Details Residency Requirement: Candidates must reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY. Remote Status: This position is 100% remote. Citizenship: Candidates must be a US Citizen or Green Card holder .
Requirements
- 10+ years of combined experience in managed care, provider contracting, network operations, and health plan operations
- Bachelor’s degree in Business, Healthcare Administration, or a related field
- Direct experience within a Health Plan or Managed Care Organization is required
- Deep knowledge of reimbursement methodologies, including fee-for-service, risk sharing, and capitation
- Candidates must reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY
- Candidates must be a US Citizen or Green Card holder
Nice To Haves
- Master’s Degree preferred
- Experience with Jiva and HRP is a significant plus
Responsibilities
- Lead negotiations for high-value provider contracts with major hospital systems
- Own complex contract modeling and network adequacy technologies
- Oversee contract performance audits and remediation strategies
- Collaborate with Actuarial, Finance, and Medical Economics teams
- Monitor and ensure compliance with federal and state regulations
- Proactively identifying and closing access gaps
- Lead due diligence for network development in expansion markets
- Identify opportunities for optimization
- Align negotiated rates with budgeted medical cost trends
- Support forecasting for unit cost increases
- Analyze claims data and market dynamics to guide contract negotiations and enhance "cost-of-care" strategies
- Build and maintain executive-level relationships with integrated delivery systems and provider organizations
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What This Job Offers
Job Type
Full-time
Career Level
Executive
