Senior Director, Network Development & Mgmt

Health Plans Inc

9h•Onsite

About The Position

At HPI, we are a forward-thinking, national third-party administrator (TPA) specializing in self-funded health plan solutions. With over 44 years of industry expertise, our entrepreneurial spirit, flexible approach, and personalized service have empowered us to serve clients of all sizes across diverse industries. We deliver innovative strategies that maximize the value of every healthcare dollar. The self-funded health plan landscape is constantly evolving. At HPI, our partners benefit from having a TPA with the expertise, resources, and creativity to deliver customized plan solutions that help them win and retain more business. We excel at driving costs down and managing risk, while enhancing our clients’ employees’ health insurance experience. Our goal is to help members clearly understand their health plan and provide responsive service, enabling them to fully utilize their benefits and achieve greater health. Our commitment extends beyond our clients to our own employees. We foster a supportive and inclusive work environment where innovation thrives. By investing in our team’s growth and well-being, we ensure they are equipped to provide exceptional service.

Requirements

Bachelor’s degree in business, healthcare administration, or similar.
15+ years of progressive experience managing provider network operations within a commercial health plan environment.
Proven leadership experience, with the ability to attract, mentor, and lead high-performing, collaborative teams.
Extensive knowledge of provider contracting, reimbursement methodologies, and provider relations.
Hands-on experience in commercial health plan network contracting and provider services.
Familiarity with self-funded employer health plan management and operations.
Significant expertise in provider network development, including physician and hospital pricing strategies, metrics, and methodologies.
Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint.

Nice To Haves

Master’s degree preferred.

Responsibilities

Collaborate with executive leadership to develop and execute provider contracting and market expansion strategies, including delivery systems, CINs, ACOs, hospitals, ancillary and national providers, behavioral health networks, specialty networks, transplant networks, Centers of Excellence, and value-based payment models.
Lead the development and management of high-performing, broad and narrow networks aligned with organizational goals.
Oversee the full provider contracting lifecycle for facilities and professionals, including credentialing processes.
Manage and enhance network adequacy, access standards, cost and quality performance, and strategic growth planning.
Design and implement provider communications to ensure contracted providers are informed and engaged in supporting member access.
Establish and monitor operational performance metrics, driving continuous improvement based on data insights.
Align network strategy with organizational objectives, supporting sales, client retention, and new market expansion.
Evaluate network performance using analytics and collaborate directly with providers and network partners to implement improvements.
Build and lead a provider support and relations unit focused on proactive communication, issue resolution, and service enhancement.
Support cost control and quality improvement strategies through performance-based provider contracts, medical management integration, and health IT utilization.
Provide oversight for chargemaster reviews, annual escalators, and neutrality to ensure financial discipline and compliance.
Partner with the Vice President of Operations to ensure accurate and timely management of provider rosters, contracting, credentialing, and provider files.
Develop and maintain a standardized roster intake and management process for timely updates to the provider directory.
Resolve contracting and provider relations issues promptly and comprehensively.
Develop, implement, and update departmental policies and procedures to reflect evolving business and regulatory needs.
Review contracts for alignment with strategic goals, policies, and compliance requirements.
Define long- and short-term strategic objectives for the department and lead execution.
Analyze provider network adequacy and performance, proactively identifying gaps and opportunities.
Ensure contracts meet regulatory, accreditor, and business requirements, making proactive adjustments as needed.
Lead negotiations and maintain collaborative relationships with key provider partners.
Direct and manage provider contracting and services teams.
Motivate and guide team members to achieve departmental goals; conduct performance reviews and address issues constructively.