Director, Provider Contracting

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

📋 Description

• Take charge of the provider contracting strategy for Gravie's health plan.

• Direct value-based care contracting and negotiate intricate network agreements.

• Oversee provider overpayment recoupment, including outreach, resolution, claims coordination, and finance recovery monitoring.

• Supervise delegated entities, including audits and corrective action plans.

• Act as the product and technology lead for the network team in collaboration with Product and Engineering.

• Manage new provider network contracts and launches in emerging markets.

• Ensure that contracts and network operations adhere to CMS, state DOI, and network adequacy standards.

• Collaborate with Finance and Actuarial on reimbursement strategies.

• Assess network adequacy and market dynamics to identify expansion opportunities.

• Serve as a senior escalation point for disputes involving provider and vendor contracts.

• Monitor industry trends and competitor positioning.

• Partner with executive leadership on network strategy, budgeting, and cost containment.

⛳️ Requirements

• Bachelor's degree or equivalent experience.

• Over 8 years of experience in provider contracting, network management, or healthcare reimbursement.

• More than 5 years of experience in negotiating value-based care arrangements, including risk-based and shared savings models.

• At least 5 years of experience in independently drafting and negotiating complex healthcare contracts and delegation agreements.

• Over 5 years of experience leading network contracting strategy and managing relationships with providers, facilities, or vendors.

• More than 3 years of experience in managing delegated entities, including oversight, audits, and compliance.

• At least 4 years of experience ensuring contracts and network operations meet CMS and state insurance regulations.

• Over 2 years of experience collaborating with Product or Engineering teams to define systems or tooling requirements.

• Proven success in leading new network builds or market launches from contracting to go-live.

• Experience in launching provider networks in new geographical regions or markets.

• Background in a small or mid-sized health plan.

• Familiarity with contracting or network configuration systems.

• Previous experience in a startup environment.

• Project or program management experience.

• Currently authorized to work in the United States.

• Must indicate whether employer visa sponsorship is needed.

🏝️ Benefits

• Coverage for alternative medicine.

• Flexible paid time off (PTO).

• Up to 16 weeks of paid parental leave.

• Paid holidays.

• 401k program.

• Transportation benefits.

• Education reimbursement.

• Two days of paid paw-ternity leave.

• Equity options.

• Bonus opportunities.