Job Details

Overview

Our client, a leading health plan in the District of Columbia, is seeking an experienced Director, Provider Network & Contracting to oversee value-based care (VBC) strategies, provider contracting, and network development. This is a key leadership role responsible for supervising a team of four, negotiating provider reimbursement and incentive-based arrangements, and ensuring the growth of a high-quality, cost-efficient provider network.

The position requires Green Card Holder or U.S. Citizenship. Candidates must be able to work onsite in Washington, DC four days per week (one day remote). A comprehensive background check (employment, education, drug screening) is required. Employees must also provide proof of flu vaccination, unless an exemption is submitted.

Responsibilities

• Lead network development, provider recruitment, contracting, and retention initiatives to ensure access to quality, cost-efficient care.
• Negotiate provider reimbursement rates, contract terms, and alternative payment methodologies (e.g., shared savings, risk sharing, bundled arrangements).
• Direct the Provider Relations team, including daily operations, hiring, performance evaluations, mentoring, and professional development.
• Develop and oversee value-based care arrangements and provider pay-for-performance programs.
• Collaborate with finance, operations, and legal teams to manage all financial, operational, and compliance aspects of provider contracts.
• Ensure compliance with all state and federal regulatory requirements, including Medicaid and Medicare standards.
• Oversee the development and implementation of provider education programs and initiatives to strengthen provider engagement.
• Monitor cost containment initiatives and implement strategies to meet strategic goals.
• Provide leadership and guidance on complex reimbursement and contracting issues, including APR-DRG hospital reimbursement methodology and claims adjudication.
• Assess market readiness for network expansion and development in targeted states.

Qualifications

Education

• Bachelor's degree in a related field required
• Master's degree in Business or Healthcare Administration preferred

Experience

• 8-10 years of experience in managed care/healthcare, with strong provider contracting and network development expertise
• 5-7 years of experience with government programs, specifically Medicaid and Medicare
• Hands-on experience with provider pay-for-performance programs and value-based care reimbursement models
• Significant experience managing provider networks (primary care and specialty) with focus on access to care
• 5-7 years of supervisory experience, including direct staff leadership and team development
• Strong knowledge of APR-DRG hospital reimbursement methodology and claims adjudication systems

Skills & Abilities

• Exceptional negotiation, problem-solving, and decision-making skills
• Strong financial acumen with proven contracting and data analysis experience
• Ability to manage multiple projects and priorities effectively
• Excellent written and verbal communication skills, including formal presentations
• Proficiency with MS Office (Word, Excel, PowerPoint) and database applications
• Demonstrated ability to build collaborative provider relationships to support quality and financial initiatives
• Knowledge of state and federal regulatory requirements, with broad experience in both commercial and government healthcare contracting

Compensation:

• This position offers a salary up to $180K (no bonus) plus benefits. Relocation support may be available depending on compensation needs.
• Competitive benefits package includes PTO, Health/Dental/Vision insurance, 401K with company contributions, and more.

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