National Director Neighborhood Networks (Contracting & Mgmt)

Cinqcare • New York, NY

9d

About The Position

CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care. The National Director, Neighborhood Networks (Contracting and Management) is a forward-thinking position responsible for developing and managing innovative partnerships with select clinical service providers and non-traditional healthcare providers to build a high-performing Preferred Provider and Social Care Network, collectively known as “Neighborhood Networks”. Neighborhood Networks enhance care delivery and coordination; support profitability; and are organized locally. This position is responsible for overseeing the Neighborhood Network contracting/network development activities across the organization and serves as the relationship owner for CINQCARE’s non-traditional network partners supporting CINQCARE programs. This role also focuses on addressing our Family Members’ Health Related Social Needs (HRSN) by integrating social determinants of health (SDOH) services to support in-home and community-based care delivery. The ideal candidate possesses deep expertise in network builds, provider contracting, including value-based care arrangements, with a proven ability to design provider networks, foster strategic partnerships, and support profitability and care coordination goals, while advancing CINQCARE’s mission.

Requirements

• Bachelor’s degree in healthcare administration, business, finance, public health, social work, or a related field; master’s degree (e.g., MBA, MHA, or MPH) required.
• 8+ years in healthcare network management, provider contracting, or leadership in community health or social services, with at least 4 years in a senior director-level or equivalent role.
• Experience with financial reports and concepts, including P&L management, healthcare financial modeling, budgeting, and forecasting, with a proven track record of driving profitability through innovative network initiatives or PPN and/or SCN development.
• Understanding of revenue cycle management (RCM), encompassing claims processing, reimbursement optimization, denial management, and revenue integrity for traditional and non-traditional providers.
• Demonstrated success in value-based contracting, preferably with ACO or payer value-based care arrangements, with a focus on improving profitability and care coordination.
• Proven experience establishing and managing Preferred Provider Networks or similar high-performing networks, including integration of non-traditional providers (e.g., CBOs, social service agencies, housing organizations).
• Track record of serving as an executive contact for community health programs, ideally across diverse regions, including underserved communities.
• Experience integrating care coordination strategies into provider networks, with a focus on in-home care delivery, HRSN, and improved clinical and financial outcomes.
• Excellent verbal, written, and presentation skills; exceptional interpersonal skills and proficiency in Microsoft Office applications.
• Ability to build and manage relationships with business leaders, providers, CBOs, coworkers, and clients while maintaining confidentiality and discretion.
• Good judgment, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial company.

Nice To Haves

• Entrepreneurial: Ability to innovate and address gaps in care delivery, aligning with CINQCARE’s mission to deliver on its promise.
• Culture: Good judgment, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding, and entrepreneurial company.

Responsibilities

• Responsible for leading a Neighborhood Network Strategy focused on developing a national Preferred Provider Network (PPN) and Social Care Network (SCN) in support of CINQCARE programs, both value-based and engagement.
• Develop and implement a strategic national plan for building and expanding a PPN and SCN with non-traditional providers (e.g., CBOs, social service agencies, housing organizations, food banks, transportation providers) and in-home care specialty providers (e.g., dental), aligned with CINQCARE’s goal of delivering health and care in the home.
• Conduct market research and environmental scans to identify high-performing, cost-efficient non-traditional solutions and partners that address HRSN, prioritizing those that align with CINQCARE’s mission to serve underserved communities and drive profitability.
• Design a PPN that integrates non-traditional providers with traditional healthcare providers, ensuring geographic coverage, service accessibility and financial sustainability.
• Develop a clear value proposition for non-traditional providers to participate in CINQCARE’s PPN and SCN, incorporating innovative contracting models (e.g., value-based contracts, shared savings, grant funding collaborations) to maximize profitability.
• Serve as the primary executive contact for non-traditional PPN and SCN partners, leading high-level discussions on program participation, contract terms, profitability goals, care coordination protocols, and strategic alignment across ACO REACH, MSSP, and payer value-based care arrangements.
• Build and maintain executive relationships with PPN and SCN leaders, social service agencies, and in-home care providers, educating them on CINQCARE’s value-based care frameworks, quality incentives, care coordination, and population health goals.
• Resolve complex partner issues, negotiate escalations, and foster collaboration to maximize financial performance, care coordination, and community impact.
• Financial oversight of the non-traditional PPN and SCN, managing profit and loss (P&L) responsibilities, budgeting, and forecasting to ensure maximum profitability and sustainability of value-based programs.
• Optimize RCM processes within PPN and SCN contracts by establishing systems, in collaboration with Finance, for invoice adjudication (when CINQCARE is the recipient of billing), reimbursement strategies, denial management, and leverage 3rd party revenue streams, where they exist, for non-traditional services.
• Collaborate with Finance and Health Care Economics teams to analyze utilization and financial data, implement cost-saving measures, and develop PPN and SCN-specific performance-based to evaluate the efficacy of PPN and SCN services.
• Support strategies to integrate care coordination into the PPN and SCN, ensuring non-traditional and traditional providers collaborate effectively with CINQCARE’s care management teams to deliver seamless, patient-centered care in the home and community that improves outcomes and reduces costs.
• Establish PPN and SCN contract terms that incentivize partners to participate in care coordination initiatives, such as shared care plans, Health Home integration, and data-sharing protocols, to enhance quality and access in underserved communities.
• Collaborate with clinical and care management teams to monitor PPN and SCN partner performance on care coordination metrics, ensuring alignment with value-based care goals, profitability objectives, and CINQCARE’s commitment to in-home care delivery.
• Direct complex contract negotiations with non-traditional providers for fee-for-service, capitation, shared savings, risk-sharing, and innovative grant-based arrangements, as appropriate, while leveraging advanced financial modeling to prioritize profitability and care coordination within the PPN and SCN; through either CMS Fee Reduction or fee schedules in instances where CINQCARE is the payor of record.
• Ensure PPN contracts comply with CMS regulations for ACO REACH, payer-specific value-based care requirements, and relevant HRSN funding guidelines, while aligning with CINQCARE’s profitability and care coordination objectives.
• Partner with Legal, Compliance, and Finance teams to draft and amend terms that maximize financial outcomes, support quality and care coordination, and drive PPN growth.
• Collaborate with internal stakeholders (e.g., clinical, quality, risk, member engagement, data analytics) to develop and implement programs that leverage non-traditional PPN and SCN services to address HRSN and improve health outcomes in the home and community.
• Identify opportunities to integrate non-traditional services into existing care pathways and value-based care programs, enhancing care coordination and profitability.
• Develop training programs for traditional and non-traditional PPN and SCN providers to promote effective collaboration and integrated care delivery.
• Monitor PPN and SCN partner performance against financial, quality, care coordination, and clinical benchmarks, using advanced analytics to drive profitability through improved care delivery and cost efficiency.
• Prepare executive-level reports on PPN and SCN performance, profitability metrics, care coordination outcomes, and program compliance for CINQCARE leadership, CMS, and payer stakeholders.
• Leverage financial and clinical insights to recommend strategic adjustments, ensuring sustained P&L growth and value-based program success.
• Represent CINQCARE in national forums, coalitions, and partnerships focused on addressing HRSNs and improving community health through innovative provider networks.
• Advocate for policies and funding that support the integration of non-traditional providers into the PPN and SCN, enhancing care coordination and profitability.

Benefits

• Medical Plans: Two comprehensive options offered to Team members.
• 401K: 4% employer match for your future.
• Dental & Vision: Flexible plans with in-network savings.
• Paid Time Off: Generous PTO, holidays, and wellness time.
• Extras: Pet insurance, commuter benefits, mileage reimbursement, CME for providers, and company-provided phones for field staff.

What This Job Offers

• Job Type: Full-time
• Career Level: Director