Health Plan Network Strategy Director (Remote)
HJ StaffingAlbuquerque, NM
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Overview
Schedule
Full-time
Career level
Executive
Remote
Remote
Job Description
HJ Staffing is seeking a Health Plan Network Strategy Director to spearhead strategic initiatives in provider contracting, network development, and adequacy. This executive-level role is responsible for building high-value partnerships with major provider organizations and managing a contract portfolio exceeding $1B annually. You will serve as the architect of our network strategy, ensuring federal and state compliance while optimizing cost, coverage, and market growth.
What You Will Do
- Strategic Contracting: Lead negotiations for high-value provider contracts with major hospital systems; own complex contract modeling and network adequacy technologies.
- Performance Oversight: Oversee contract performance audits and remediation strategies, collaborating with Actuarial, Finance, and Medical Economics teams.
- Network Adequacy: Monitor and ensure compliance with federal and state regulations, proactively identifying and closing access gaps.
- Market Expansion: Lead due diligence for network development in expansion markets and identify opportunities for optimization.
- Financial Stewardship: Align negotiated rates with budgeted medical cost trends and support forecasting for unit cost increases.
- Data-Driven Strategy: Analyze claims data and market dynamics to guide contract negotiations and enhance "cost-of-care" strategies.
- Relationship Management: Build and maintain executive-level relationships with integrated delivery systems and provider organizations.
What You Will Bring
- Experience: 10+ years of combined experience in managed care, provider contracting, network operations, and health plan operations.
- Education: Bachelor's degree in Business, Healthcare Administration, or a related field (Master's Degree preferred).
- Industry Expertise: Direct experience within a Health Plan or Managed Care Organization is required.
- Technical Proficiency: Experience with Jiva and HRP is a significant plus.
- Subject Matter Expertise: Deep knowledge of reimbursement methodologies, including fee-for-service, risk sharing, and capitation.
You Will Be Successful If:
- You are a master of financial analytics with the business acumen to manage complex, multi-market environments.
- You possess elite communication skills and are comfortable with public speaking and executive presentations.
- You stay at the forefront of national healthcare policies and emerging care delivery models.
- You can navigate and influence large integrated delivery systems and joint ventures effectively.
Important Details
- Residency Requirement: Candidates must reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY.
- Remote Status: This position is 100% remote.
- Citizenship: Candidates must be a US Citizen or Green Card holder.
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FAQs About Health Plan Network Strategy Director (Remote) Jobs at HJ Staffing
What is the work location for this position at HJ Staffing?
This job at HJ Staffing is located in Albuquerque, NM, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.
What pay range can candidates expect for this role at HJ Staffing?
Employer has not shared pay details for this role.
What employment applies to this position at HJ Staffing?
HJ Staffing lists this role as a Full-time position.
What experience level is required for this role at HJ Staffing?
HJ Staffing is looking for a candidate with "Executive" experience level.
Does HJ Staffing allow remote work for this role?
Yes, this position at HJ Staffing supports remote work, giving candidates the flexibility to work outside the primary office location.
What is the process to apply for this position at HJ Staffing?
You can apply for this role at HJ Staffing either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.