AVP – Provider Strategy, Contracting

This is a fully remote position, open to applicants in United States.

📋 Description

• Spearhead the development and implementation of comprehensive provider network and contracting strategies across the enterprise to ensure network adequacy, competitive positioning, and alignment with business growth objectives.

• Establish and drive multi-year provider contracting roadmaps that encompass rate strategies, value-based care models, and risk-sharing agreements.

• Supervise network design, expansion, and optimization across various markets, ensuring alignment with cost-of-care targets, access standards, and product strategies.

• Leverage market intelligence, competitive insights, and performance analytics to guide network composition and contracting priorities.

• Ensure that network configurations maintain a balance between cost efficiency, quality outcomes, and provider access, which includes optimizing high-performing and preferred provider tiers.

• Oversee the complete provider network development process, including contracting strategies, negotiation execution, reimbursement methodologies, and ongoing performance management.

• Create and implement innovative contracting models (e.g., value-based care, bundled payments, shared savings, capitation when appropriate) to enhance cost, quality, and experience outcomes.

• Lead intricate provider negotiations with health systems, specialty providers, and ancillary partners, ensuring alignment with financial objectives and strategic priorities.

• Identify and execute opportunities to enhance network performance through contract optimization, utilization management alignment, and provider incentives.

• Manage network capacity planning, coverage adequacy, and provider mix optimization to fulfill demand and growth projections.

• Propel enhancements to provider-facing tools, systems, and processes to boost operational efficiency and experience.

• Ensure all network initiatives and contracting programs meet defined KPIs, including affordability, unit cost reductions, ROI, and performance guarantees.

• Collaborate with Product, Clinical, and Market leaders to align network capabilities with product design and clinical program requirements.

• Guarantee that provider contracts and reimbursement structures support new product features, care models, and clinical program requirements.

• Facilitate scalable network and contracting solutions to support new market entry, product launches, and client-specific configurations.

• Direct the development of network-related program capabilities and positioning to support client growth and retention.

• Work closely with Sales, Underwriting, Medical Economics, and Actuarial teams to align network contracting strategies with pricing, underwriting assumptions, and growth targets.

• Assist in pre-sale and post-sale activities through network strategy articulation, provider disruption analysis, and competitive positioning.

• Ensure timely adaptation of network models to respond to the evolving healthcare landscape and client needs.

• Act as a key liaison between Network Management, Product/Network Analytics, Medical Economics, Provider Experience, Clinical Operations, Compliance, Revenue Cycle Management (RCM), Implementations, and Operations teams.

• Align stakeholders around contracting strategies, financial objectives, and execution plans, ensuring seamless operationalization.

• Provide strategic input into enterprise priorities, including cost-of-care management, provider partnerships, and long-term growth strategies.

• Represent CareCentrix in high-level negotiations with provider organizations, health systems, and strategic partners.

• Cultivate and maintain strong, collaborative relationships with providers that facilitate favorable contracting outcomes and long-term partnership value.

⛳️ Requirements

• Bachelor’s degree is required; a Master’s or MBA is strongly preferred.

• 8–12+ years of experience in healthcare, with a significant emphasis on provider network development, contract negotiations, operations, provider credentialing, and provider communications/engagement and strategy.

• Proven experience in building and managing provider networks, ensuring network adequacy and market expansion.

• Experience in leading cross-functional initiatives and influencing senior stakeholders.

• Strong understanding of healthcare delivery models, ideally within home health or post-acute care.

• Demonstrated ability to drive operational improvements, manage complex programs, and lead high-performing teams.

• Strategic thinker with a strong focus on execution.

• Data-driven decision-making and analytical skills.

• Exceptional communication and stakeholder management abilities.

• Ability to navigate change and ambiguity effectively.

• Strong problem-solving skills and organizational leadership capabilities.

🏝️ Benefits

• Medical

• Dental

• Vision

• 401(k) with company match

• HSA employer contributions

• Dependent Care FSA employer contribution

• Paid Time Off

• Personal/Sick Time

• Paid Parental Leave

• Corporate bonus incentive