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AVP – Provider Strategy, Contracting
Job Description:
- Lead the development and execution of enterprise-wide provider network and contacting strategies to ensure network adequacy, competitive positioning, and alignment with business growth objectives
- Define and drive multi-year provider contracting roadmaps, including rate strategy, value-based care models, and risk-sharing arrangements
- Oversee network design, expansion, and optimization across markets, ensuring alignment to cost-of-care targets, access standards, and product strategy
- Utilize market intelligence, competitive insights, and performance analytics to inform network composition and contracting priorities
- Ensure network configurations balance cost efficiency, quality outcomes, and provider access including optimization of high performing and preferred provider tiers
- Direct end-to-end provider network development, including contracting strategy, negotiation execution, reimbursement methodologies, and ongoing performance management
- Establish and implement innovative contracting models (e.g. value-based care, bundled payments, shared savings, capitation where appropriate) to drive cost, quality, and experience outcomes
- Lead complex provider negotiations with health systems, specialty providers, and ancillary partners, ensuring alignment with financial targets and strategic priorities
- Identify and executive opportunities to strengthen network performance through contract optimization, utilization management alignment, and provider incentives
- Oversee network capacity planning, coverage adequacy, and provider mix optimization to meet demand and growth projections
- Drive enhancements to provider-facing tools, systems, and processes to improve operational efficiency and experience
- Ensure all network initiatives and contracting programs delivery against defined KPIs, including affordability, unit cost reductions, ROI and performance guarantees
- Partner with Product, Clinical, and Market leaders to align network capabilities with product design and clinical program requirements
- Ensure provider contracts and reimbursement structures support new product features, care models and clinical program requirements
- Enable scalable network and contracting solutions to support new market entry, product launches, and client-specific configurations
- Lead the development of network-related program capabilities and positioning to support client growth and retention
- Partner closely Sales, Underwriting, Medical Economics, and Actuarial teams to align network contracting strategy with pricing, underwriting assumptions and growth targets
- Support pre-sale and post-sale activities through network strategy articulation, provider disruption analysis, and competitive positioning
- Ensure timely adaptation of network models in response to evolving healthcare landscape and client needs
- Serve as a key liaison between Network Management, Product / Network Analytics, Medical Economics, Provider Experience, Clinical Operations, Compliance, Revenue Cycle Management (RCM), Implementations and Operations teams
- Align stakeholders around contracting strategies, financial targets, and execution plans, ensuring seamless operationalization
- Provide strategic input into enterprise priorities, including cost-of-care management, provider partnerships, and long-term growth strategy
- Represent CareCentrix in executive-level negotiations with provider organizations, health systems and strategic partners
- Build and maintain strong, collaborative provider relationships that enable favorable contracting outcomes and long-term partnership value
Requirements:
- Bachelor’s degree required; Master’s or MBA strongly preferred
- 8–12+ years of experience in healthcare, with significant focus on provider network development, contract negotiations operations, provider credentialing, provider communications/engagement and strategy
- Demonstrated experience building and managing provider networks, including network adequacy and market expansion
- Experience leading cross-functional initiatives and influencing senior stakeholders
- Strong understanding of healthcare delivery models, ideally within home health or post-acute care
- Proven ability to drive operational improvements, manage complex programs, and lead high-performing teams
- Strategic thinking with strong execution orientation
- Data-driven decision-making and analytical capability
- Excellent communication and stakeholder management skills
- Ability to lead through change and ambiguity
- Strong problem-solving and organizational leadership skills
Benefits:
- Medical
- Dental
- Vision
- 401(k) with company match
- HSA employer contributions
- Dependent Care FSA employer contribution
- Paid Time Off
- Personal/Sick Time
- Paid Parental Leave
- corporate bonus incentive
