Lead Director, Network Management (Oklahoma)

About the role

The Lead Director will manage the development of contracts and agreements with providers and delivery systems, ensuring consistency with all contracting strategies and meeting and exceeding accessibility, quality, compliance, and financial goals and cost initiatives.

Responsibilities

• Negotiates and executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts with larger and more complex, market-based, group/system providers.
• Manages contract performance and supports the development and implementation of value-based contract relationships in support of business strategies.
• Recruits providers as needed to ensure attainment of network expansion and adequacy targets.
• Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review analysis of reports as part of negotiation and reimbursement modeling activities.
• Identifies and manages cost issues and collaborates cross functionally to execute significant cost saving initiatives.
• Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.
• Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.
• Collaborates with internal partners to assess effectiveness of tactical plan in managing costs.
• Mentor and coach new/more junior staff to educate and inform on accreditation and regulatory standards as well as policies on credentialing and re-credentialing.

Requirements

• 10+ years of related healthcare contracting experience, including expert-level negotiation skills and a proven track record of successfully negotiating contracts with large, complex national providers and vendor organizations.
• 2+ years of people leadership experience, with demonstrated ability to lead, develop, and influence high-performing teams.
• Strong knowledge of provider financial management, competitive market strategies, complex contracting methodologies, value-based and risk-based arrangements, and applicable regulatory requirements.
• Demonstrated success identifying and leading initiatives that improve total cost of care, enhance quality outcomes, and drive organizational performance.
• Extensive experience within a health plan, payer, or provider system environment, with a deep understanding of healthcare delivery and reimbursement models.

Preferred Qualifications

• Experience with Medicaid regulatory requirements, including demonstrated knowledge of compliance standards and state-specific program guidelines.
• Direct experience working with providers in Oklahoma, with an understanding of the state's Medicaid market and provider landscape.
• Working knowledge of value-based care and alternative payment arrangements, including value-based contracting principles and performance-based reimbursement models.