Provider Contracting Director – Transplant

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

📋 Description

• Spearhead intricate contract negotiations with hospitals, transplant centers, physician groups, and advanced cellular therapy providers throughout the Northeast

• Negotiate reimbursement rates, financial agreements, contract language, renewals, amendments, and new provider contracts

• Create agreements utilizing fee-for-service, case rates, bundled payments, DRGs, and value-based arrangements

• Oversee financial and operational performance of assigned provider agreements, focusing on unit-cost targets and affordability initiatives

• Analyze claims, medical, financial, and market data to pinpoint contracting opportunities, evaluate financial implications, and enhance negotiation strategies

• Maintain a comprehensive understanding of the Northeast provider landscape, competitive dynamics, network gaps, market relationships, and industry trends

• Identify and recruit providers that enhance network access, adequacy, quality, and geographic coverage

• Foster relationships with provider executives and contracting leaders while addressing escalations, performance issues, and potential contract terminations

• Decode contract language and coordinate the implementation and administration of negotiated terms

• Collaborate with Medical Economics, Clinical, Product, Operations, local market teams, Legal, Compliance, and other stakeholders on network strategies

• Act as the primary point of accountability for assigned provider relationships and regional contracting initiatives

• Handle multiple negotiations and deliverables simultaneously in a complex, highly matrixed environment

• Travel within the Northeast territory as required for provider meetings and negotiations

⛳️ Requirements

• Bachelor’s degree or equivalent relevant professional experience

• A minimum of five years of experience in commercial healthcare contracting and negotiations involving hospitals, health systems, large physician groups, or other complex delivery organizations

• Proven experience negotiating reimbursement, financial terms, and contractual language with sophisticated provider organizations

• In-depth understanding of hospital, managed-care, and provider business models

• Experience in independently managing a significant portfolio of active contracts and simultaneous negotiations

• Strong financial acumen, including the ability to interpret reimbursement models, claims information, contract performance, and financial analyses

• Capability to develop and maintain relationships with senior provider executives and internal business leaders

• Exceptional negotiation, problem-solving, decision-making, organizational, and written and verbal communication skills

• Ability to work independently, rapidly shift priorities, and achieve results in a fast-paced matrix organization

• Proficiency in Microsoft Excel, Word, PowerPoint, and related business tools

• Reliable internet connection through cable broadband or fiber optic service with a minimum of 10Mbps download/5Mbps upload when working from home

• Preferred: Experience in transplant, stem-cell, or advanced cellular therapy contracting

• Preferred: Experience in negotiating bundled or case-rate arrangements for complex episodes of care

• Preferred: Knowledge of commercial hospital contracting, network affordability, and provider incentive programs

• Preferred: Experience with contract modeling, redlining, network analytics, and strategic provider negotiations

• Preferred: Familiarity with internal healthcare payer operations and cross-functional contract implementation

• Preferred: Established knowledge of provider markets in the Northeast

🏝️ Benefits

• Eligibility for an annual bonus plan

• Medical insurance coverage

• Vision insurance coverage

• Dental insurance coverage

• Access to well-being and behavioral health programs

• 401(k) retirement plan

• Company-paid life insurance

• Tuition reimbursement opportunities

• A minimum of 18 days of paid time off annually

• Paid holidays

• Leaves of absence

• Remote work arrangement available

• Requirement for cable broadband or fiber optic internet for home working