Health Plan Network Strategy Director

10+ years of combined experience in managed care, provider contracting, network operations, and health plan operations Bachelor’s degree in Business, Healthcare Administration, or a related field Direct experience within a Health Plan or Managed Care Organization Experience with Jiva and HRP is a significant plus Deep knowledge of reimbursement methodologies Mastery of financial analytics Elite communication skills Knowledge of national healthcare policies and emerging care delivery models

Lead negotiations for high-value provider contracts Oversee contract performance audits and remediation Monitor and ensure compliance with network adequacy regulations Lead due diligence for network development in expansion markets Align negotiated rates with budgeted medical cost trends Analyze claims data and market dynamics to guide negotiations Build and maintain executive-level relationships with providers