AVP, Contracting & Network Management

Hospital Contracting Strategy & Execution

Lead the development and execution of contracting strategies for hospital systems, including acute care hospitals, specialty facilities, and integrated delivery networks (IDNs).

Negotiate highly complex agreements with hospital executives, including fee-for-service, DRG-based, case rate, bundled payment, and value-based/risk arrangements.

Drive alignment of hospital contracts with organizational financial targets, medical cost management, and quality outcomes.

Lead renegotiations and strategic realignment of hospital participation within networks.

Enterprise Provider Contracting Oversight

In conformance with corporate standards, accountable to lead, manage, negotiate, and implement all types of provider network contracts, including but not limited to IPAs/medical groups, hospitals, direct network physicians, ancillary providers, and supplemental vendors, across both delegated and non-delegated arrangements, serving as a subject matter expert in contract language, structure, and terms.

Ensure consistency, scalability, and appropriate governance across all provider contracting activities.

Innovation & Value-Based Care

Develop and execute strategies for innovative approaches to create value through next-generation contracting, network design, and care models for Medicare Advantage, inclusive of diverse compensation arrangements (e.g., capitation, shared savings, global risk, quality incentives and value-based structures).

Advance value-based arrangements and risk-sharing models that improve outcomes and reduce total cost of care, ensuring alignment of financial incentives, contract structures, and performance expectations.

Network Strategy & Design

Develop and execute forward-looking strategies for network design, including narrow, tiered, and high-performance networks.

Leverage the competitive landscape to assess market dynamics and design differentiated network and contracting strategies.

Ensure networks meet access, CMS adequacy, affordability, and quality standards across all products.

Financial & Analytical Leadership

Oversee financial modeling and analytics supporting contract negotiations, including rate development, impact modeling, and ROI analysis.

Monitor key performance indicators such as unit cost trends, utilization, and provider performance.

Identify opportunities for cost containment, efficiency, and value optimization across the network.

Leadership & Operational Excellence

Establish department key performance indications, define success measures, and set clear performance expectations for staff and market leadership.

Lead, mentor, and develop a high-performing contracting and network management team.

Drive accountability, transparency, and continuous improvement within the function.

Cross-Functional Collaboration

Partner with Finance, Market leadership, Clinical, Legal, Compliance, Product and other key functional areas to align contracting strategies with enterprise goals.

Serve as a strategic advisor to executive leadership on hospital market dynamics and network performance.

Compliance & Risk Management

Ensure all contracting activities comply with federal and state regulations, including CMS requirements.

Partner with Legal to mitigate contractual risk and maintain strong governance and standardized contract language.

Supervisory Responsibilities

Oversees assigned staff that support the network management needs of the markets. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.