Senior Director, Care Delivery Org – Value Based Care Contracting

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

📋 Description

• Formulate and implement a value-based contracting strategy that aligns with overall cost and quality objectives.

• Create alternative payment models and negotiate high-value agreements with IPAs, large physician groups, health systems, and other provider organizations.

• Manage the entire contracting process, from planning and document preparation to negotiation, execution, and submission for system loading.

• Spearhead negotiations for intricate provider contracts and facilitate meetings with external providers.

• Synchronize negotiation strategies with goals related to network accessibility, quality, compliance, and financial performance.

• Develop strategic plans focused on value and supervise contract performance with selected provider groups.

• Assess and implement network strategies to accomplish contracting objectives and control medical expenses.

• Analyze medical claims data, identify cost trends, and create executive summaries.

• Model risk-based contracting scenarios and provide support for business cases concerning contract structures and cost-saving initiatives.

• Build, lead, and manage the MSO Contracting team.

• Recruit, onboard, mentor, evaluate performance, and retain contracting personnel.

• Coordinate contract support with HEDIS, Credentialing, Grievance & Appeals, SIU, and Member Services.

• Oversee complex, multi-stakeholder contracting projects from assessment to implementation.

• Ensure that project milestones, stakeholder alignment, and deliverables are achieved on time.

⛳️ Requirements

• At least 10 years of relevant experience in value-based contract negotiation within managed care, Medicare Advantage, or healthcare services sectors.

• Proven history of negotiating value-based contracts with IPAs, large complex provider systems, hospitals, and major physician organizations.

• Exceptional negotiation skills, including experience with full-risk, shared savings, capitation, and alternative payment models.

• Proficient in reviewing medical claims data and crafting executive summaries to address medical cost trends.

• Demonstrated capacity to function effectively in a matrixed organization and foster cross-functional collaboration.

• Experience managing the complete contracting process from strategy development and planning to execution and contract loading.

• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field; equivalent combinations of professional experience and education will be accepted.

• Demonstrated knowledge of value-based care models, alternative payment methodologies, and Medicare Advantage contracting frameworks through practical experience.

• Advanced skills in value-based contract negotiations.

• Proficient in analyzing medical claims and financial data.

• Advanced understanding of alternative payment model design and strategy.

• Strong skills in network strategy and provider relationship management.

• Advanced ability to influence cross-functional teams and align stakeholders.

• Intermediate to advanced knowledge of CMS Stars and HEDIS.

• Advanced project management and program leadership capabilities.

🏝️ Benefits

• Fully remote work environment.

• Equal Opportunity/Affirmative Action employer.

• Reasonable accommodations available for individuals with disabilities.