Director, Network Partnerships & Contracting

Accountabilities

• Lead the development and execution of new provider network partnerships, identifying priority markets, evaluating partnership models, and negotiating agreements through signature and implementation.
• Own new network launches end to end, ensuring networks are competitively priced, operationally ready, compliant, and launched according to established timelines.
• Analyze market intelligence, network economics, reimbursement rates, competitor positioning, and regulatory developments to inform market-entry and network strategy decisions.
• Build and maintain relationships with prospective network partners, clearly communicating the organization's value proposition and translating market insights into actionable partnership strategies.
• Evaluate regional leased-network opportunities and innovative models, including centers of excellence, advanced primary care, and value-based care arrangements, to support go/no-go and market prioritization decisions.
• Negotiate complex healthcare agreements with providers, hospitals, health systems, physician groups, network partners, and vendors, including high-value provider recoupments.
• Develop complete implementation packages for executed agreements and resolve contractual questions or discrepancies that arise during implementation.
• Ensure network contracts and operations satisfy applicable federal and state requirements, including network adequacy standards and requirements associated with the No Surprises Act.
• Absorb national network solutions and leased-network competitiveness through rate benchmarking, discount validation, and economic analysis.
• Own contract lifecycle management, maintaining the contract repository as the single source of truth and monitoring renewals, terminations, notices, escalators, amendments, and reporting obligations.
• Serve as the senior escalation point for provider and vendor contract disputes, driving issues toward timely and commercially sound resolutions.
• Monitor healthcare industry trends and competitor strategies to keep contracting and network approaches differentiated and responsive to market changes.
• Partner with executive leadership on network strategy, budgeting, cost containment, and broader growth initiatives.
• Collaborate cross-functionally with Sales, Product, Marketing, Engineering, Finance, Actuarial, and Compliance to translate network capabilities into scalable products and compelling market propositions.

  Requirements

  • Bachelor's degree or equivalent practical experience, with 8+ years of experience in provider contracting, network management, healthcare reimbursement, or network strategy.
  • Deep knowledge of provider payment methodologies, including DRGs and case rates, per diems, percentage-of-charges arrangements, and fee schedules.
  • 5+ years of experience in contracting or network roles supporting commercial group markets and employer-sponsored health plans, including self-funded, level-funded, or fully insured products.
  • Strong understanding of TPA, ASO, and/or leased-network arrangements and their implications for network strategy and contracting.
  • 5+ years of experience independently drafting and negotiating complex healthcare agreements, including direct agreements with hospitals, health systems, and physician groups.
  • 4+ years of experience ensuring healthcare contracts and provider networks meet federal and state regulatory requirements, including state Department of Insurance network adequacy standards and federal requirements such as the No Surprises Act.
  • 3+ years of experience developing and negotiating value-based care arrangements, including shared savings, risk-based models, bundled payments, or pay-for-performance structures.
  • 2+ years of cross-functional experience bringing network products to market, partnering with Sales, Product, Marketing, Engineering, and related teams to define go-to-market strategies and communicate network value and differentiation.
  • Strong analytical and commercial judgment, with the ability to evaluate complex network economics and translate data into clear strategic recommendations.
  • Excellent negotiation, relationship-building, communication, and executive-facing presentation skills.
  • Ability to operate independently, manage multiple priorities, and make sound decisions in a fast-paced, high-performance environment.

  Preferred

  • Experience launching provider networks in new geographies or markets.
  • Experience working within a small or mid-sized health plan where cross-functional collaboration is essential.
  • Familiarity with network configuration or contracting systems and their development or optimization.
  • Startup experience and/or project or program management experience.

  Benefits

  • Comprehensive health and wellness benefits designed to support employees and their families.
  • Alternative medicine coverage as part of the broader health benefits package.
  • Flexible paid time off (PTO) to support flexibility and work-life balance.
  • Up to 16 weeks of paid parental leave.
  • Paid holidays.
  • 401(k) program to support long-term financial planning.
  • Transportation perks.
  • Education reimbursement to support ongoing learning and professional development.
  • Opportunity to work in a fast-paced, merit-driven, collaborative environment with significant ownership and cross-functional exposure.
  • The chance to directly influence healthcare network strategy, market expansion, and products designed to improve benefits for employees and businesses.