Sr. Director - Provider Contracting

About the role

We are currently seeking a highly motivated Senior Director – Provider Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Monterey Park, CA, Orange, CA, and at home on a weekly basis. This role will work closely with the VP of Contracting to develop and execute on managed care contracting strategies and negotiations.

Responsibilities

• Design and oversee provider contracting strategies that align with organizational goals for growth, compliance, and cost-effectiveness
• Act as a thought leader, providing executive-level guidance on payer and provider contracting initiatives
• Direct and ensure proper administration of Division of Financial Responsibility (DOFRs), contract amendments, RFPs, and CAPs arising from Health Plans
• Oversee project management of all payer and provider contracting initiatives, ensuring execution within timelines and compliance requirements
• Lead delegation oversight and compliance reviews to minimize risk exposure, sanctions, and financial penalties
• Interpret and assess contractual risk in provider-facing and payer-facing agreements, leading high-stakes, time-sensitive negotiations
• Ensure contracts are structured to optimize reimbursement, protect the organization’s interests, and enhance provider relationships
• Establish and maintain policies and processes that streamline contract review, approval, and execution across the enterprise
• Partner with Claims, Configuration, Business Development, and Data Management teams to align operational processes with contracting strategies
• Drive root-cause solutions to systemic issues affecting contract performance or compliance
• Provide executive-level reports and recommendations to senior leadership on network adequacy, financial impact, and strategic opportunities
• Provide direction, coaching, and mentorship to Payer Relations Associates and contracting team members
• Efficiently delegate and coordinate workflow of contracts and health plan communications across the department
• Build organizational capability through continuous improvement, training, and development of team members

Qualifications

• Demonstrated ability to analyze complex financial data, contracts, and regulatory documents with a high degree of accuracy and insight
• Proven problem-solving skills with a strategic, methodical approach to addressing challenges and driving sustainable solutions
• Exceptionally detail-oriented, highly organized, and skilled at leading teams through exhaustive investigations where information may be ambiguous or incomplete
• Superior communication skills—both verbal and written—with the ability to translate technical and contractual language into clear recommendations for executives and stakeholders
• Deep understanding of delegated network operations and regulatory requirements, with experience overseeing compliance in complex healthcare environments
• Advanced proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and ability to leverage tools for strategic presentations, contract modeling, and executive reporting
• Knowledge of EZ-Cap and other proprietary healthcare administration systems, with the ability to oversee teams that utilize these platforms effectively

Environmental Job Requirements and Working Conditions

The organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754 and 600 City Parkway West, Orange, CA 92868. The annual total compensation target pay range for this role is: $175,000 - $185,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.