Director, Network Performance and Strategy – Preferred Experience in Managed Care

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

📋 Description

• Deliver strategic direction for the enterprise Network Performance and Strategy function across various markets and business lines.

• Create standardized frameworks to assess provider performance, network adequacy and access, utilization, affordability, leakage/OON utilization, quality, contracting performance, and other network metrics.

• Convert network performance intelligence into strategies that enhance market performance, affordability, quality, network adequacy, growth, and competitive positioning.

• Counsel network leadership using enterprise benchmarks, insights, and scalable solutions.

• Set enterprise standards and methodologies for managing network performance.

• Spearhead the development of network performance reporting, analytics, decision-support tools, automation, AI, and proprietary platforms.

• Collaborate with Medical Economics and Actuarial leadership on network performance methodologies and analytical frameworks.

• Partner with Value-Based Contracting leadership on provider segmentation, performance insights, and VBC strategies.

• Work alongside Network Contracting on contracting priorities, provider targeting, reimbursement strategies, and network optimization.

• Identify and prioritize enterprise network opportunities, developing robust business cases.

• Oversee the implementation of network performance capabilities across markets, ensuring adoption, change management, and measurable business impacts.

• Assess emerging technologies, data sources, vendors, and industry practices.

• Formulate and manage the team's operational plan, talent strategy, priorities, and resource distribution.

• Represent Network Performance & Strategy to executive leadership and cross-functional stakeholders.

• Establish accountability for measurable outcomes and evaluate the team's impact on network performance and business objectives.

• Carry out additional job-related responsibilities as assigned.

⛳️ Requirements

• A Bachelor's degree in healthcare administration, business, analytics, economics, public health, or a related field is mandatory.

• Equivalent years of relevant work experience may be considered in lieu of the required educational qualifications.

• A minimum of ten (10) years of progressive experience in managed care, healthcare strategy, network management, provider performance, medical economics, healthcare analytics, or related fields is required.

• At least five (5) years of experience in leadership roles is necessary.

• Experience in Medicaid managed care and/or Medicare Advantage is favored.

• Familiarity with network optimization, provider performance, value-based care, reimbursement, or medical cost management is preferred.

• Demonstrated understanding of health-plan network strategy, provider performance, healthcare economics, and managed-care operations is essential.

• Proficient in utilizing advanced analytics, AI, or technology-enabled operating models.

• Expertise in leading enterprise capabilities across a geographically diverse health-plan organization.

• Experience operating across multiple markets, business units, or lines of business is beneficial.

• Excellent executive communication, relationship management, and strategic problem-solving abilities are required.

• Proficient in enterprise network strategy and network performance management.

• Familiarity with healthcare economics is an advantage.

• Strong executive leadership and cross-functional influence skills are essential.

• Competency in developing and analyzing market strategy is needed.

• Knowledgeable in provider performance and skilled in change management.

• Proficient in data-driven decision-making and organizational leadership.

• No specific licensure or certification is required.

• Regular travel of up to 25% may be necessary.

🏝️ Benefits

• A bonus linked to company and individual performance may be available.

• A substantial and comprehensive total rewards package is offered.

• Comprehensive total well-being support is provided.

• A remote work arrangement is available.