[Hiring] Network Contracting Director @CareMore Health

Role Description

The Director, Network Contracting is responsible for leading the strategy, development, medical expense management, and oversight of CareMore Health’s hospital and ancillary provider networks, ensuring high-quality, coordinated, and cost-effective care. This leadership role oversees a small team of contracting professionals responsible for negotiating, implementing, and administering agreements serving Medicare Advantage, Medicaid, and other managed care populations.

Qualifications

• Strategic Leadership
• Contracting & Network Management
• Analytics & Strategic Planning
• Leadership & Talent Development
• Financial & Business Partnership
• Governance & Operational Excellence

Requirements

• Develop and execute the hospital and ancillary contracting strategy in alignment with CareMore Health's enterprise objectives, value-based care initiatives, affordability targets, and market growth priorities.
• Translate long-term network strategies into annual contracting plans, measurable business objectives, and operational priorities across multiple provider segments and geographic markets.
• Lead contracting strategies that improve access, satisfy network adequacy, affordability, quality performance, and member experience.
• Evaluate healthcare market trends, competitive intelligence, reimbursement innovation, and regulatory changes to proactively position CareMore's hospital and ancillary network for future growth and sustainability.
• Provide executive oversight of contracting activities across hospital and ancillary networks.
• Guide negotiations for high-value, strategically significant agreements, serving as executive sponsor for complex negotiations.
• Oversee reimbursement strategies, alternative payment models, and value-based contracting initiatives that support improved patient outcomes and financial sustainability.
• Ensure timely execution, implementation, and ongoing administration of hospital and ancillary agreements while maintaining compliance with organizational policies and regulatory requirements.
• Monitor contract performance and partner with internal stakeholders to address network gaps and contracting opportunities while controlling medical expense and meaningfully reducing the cost of care.
• Leverage analytics, financial modeling, utilization data, and market intelligence to evaluate performance and identify contracting opportunities.
• Complete financial and performance modeling for non-complex contract changes to develop rate proposals, form negotiation strategy, and measure impact to the business.
• Lead, coach, and develop a high-performing contracting organization of contracting professionals.
• Establish clear performance expectations, succession plans, and professional development opportunities that build organizational capability and leadership bench strength.
• Foster a culture of accountability, collaboration, innovation, continuous improvement, and customer service across the contracting organization.
• Ensure effective workload planning, resource allocation, prioritization, and organizational alignment to meet evolving business priorities.
• Partner with Finance, Local Markets, Clinical Operations, Utilization Management, and Strategy leaders to evaluate the financial and operational impacts of contracting decisions.
• Oversee development of executive reporting, performance analyses, reimbursement modeling, and contracting analytics that support enterprise decision-making.
• Provide strategic recommendations regarding reimbursement methodologies, network optimization, and healthcare affordability initiatives.
• Monitor cost trends, utilization patterns, quality performance, and network economics to identify opportunities for improvement and risk mitigation.
• Establish and maintain enterprise contracting governance, documentation standards, contract lifecycle management processes, and operational controls.
• Partner with Legal, Compliance, Credentialing, Configuration, Provider Operations, and Claims leadership to ensure seamless implementation and administration of agreements.
• Ensure compliance with delegated Health Plan requirements, network adequacy standards, accreditation requirements, and organizational policies.
• Lead continuous improvement initiatives that enhance contracting workflows, operational efficiency, reporting capabilities, and data integrity.
• Adapt quickly to changing business priorities and operate effectively in ambiguous environments.
• Represent CareMore Health in executive provider meetings, industry forums, and strategic partnership discussions as appropriate.

Benefits

• Compensation Range: $157,492.00 to $236,238.00
• The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting.
• Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.