Director, Provider Network Value Contracting

The Director, Provider Network Value Based Contracting is accountable for the staff responsible for the strategy, development, execution and management of alternative contracting, including, but not limited to, total cost of care (TCOC) contracting negotiations, bundles, alternative payment arrangements and network development.

Provider contracting is the foundation for development of alternative payment arrangements as well as the financial strategy that moves reimbursement from total fee for service to risk sharing with providers. This type of contracting is key in developing products and financial strategies around provider relationships and supports the organization’s market strategies for both new and existing markets, as well as financial objectives.

The contracting model for alternative arrangements is complex and could contain both cost/utilization factors as well as quality measurement performance. The incumbent is required to identify and cultivate key provider relationships for consideration of differential payment terms. The Director, Provider Contracting requires an ability to think strategically and have a thorough understanding of the financial modeling and impacts in the execution of alternative arrangements.

• Responsible for leading the contract managers to successfully execute contracting arrangements, including alternative payment terms, with providers in a timely, accurate fashion.
• Provides leadership, coaching, and skill development for the Provider contracting team. Ensures that the team has appropriate tools, skills, reports and legal documents to effectively accomplish assigned responsibilities (Staff Development and training, Advocate for team, and Performance Management).
• Provides first level of escalation during contract negotiations.
• Develops, Oversees network development activities.
• Provides leadership to contracting staff by communicating organizational and department strategies, objectives and lead activities to execute against strategies.
• Execute against network-specific activity to support business segment strategic plans, ensuring market competitive position.
• Coordinates network contracting activities with Provider Finance, Operations and Legal in understanding data analytics, operational compatibility and sound legal instruments.

• Establishes and improves processes and policies and procedures.
• Provides staff guidance on negotiating contracts in collaboration with appropriate internal areas.
• Develops business tools to support/optimize the provider contracting function.
• Manages/develops/participates in company-wide, inter-, and intra-departmental performance improvement projects.

• Partners with Legal and Compliance in ensuring Network is in compliance with applicable regulatory changes.

• Build and maintain positive working relationships with Medica’s key providers.
• Develop and execute against provider-specific strategies, goals and objectives to support business segment objectives.

• Bachelor's degree in business or related field.
• 10+ years working as a successful contract negotiator for health care services, provider or health plan.
• Proven track record as a team leader with staff management skills.

• Excellent communication (written, verbal and presentation) skills.
• Director will define the contracting strategy, initiate negotiations with payers, and ensure contract terms position the organization for successful financial performance.
• Lead the strategic direction and vision for the value-based care contracting function, ensuring alignment with organizational goals and industry trends.
• Establish and maintain solid relationships with payer representatives, resolving contract-related issues and fostering collaboration.
• Collaborate with cross-functional teams to implement contracts and address operational challenges.
• Establish and maintain solid relationships with provider partners.
• An understanding and appreciation for standardizing processes to generate efficiencies and improve service levels.

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