Job Details

Location: Remote but must reside in New Mexico, California, Illinois, North Dakota, New York, Ohio, Washington, or Wyoming

Description:
We are seeking a Health Plan Network Strategy Directorto lead strategic initiatives in provider contracting, network development, and adequacy. This role is responsible for building and maintaining high-level partnerships with provider organizations, ensuring compliance with federal and state regulations, and supporting access and availability standards. The strategist will conduct ongoing cost, coverage, and growth analyses of the provider network and identify opportunities for expansion or optimization to align with health plan goals.

What You Will Do:

• Leading the development and negotiation of high-value provider contracts-exceeding $1B annually-with major hospital systems and provider organizations.
• Owning complex contract modeling and network adequacy technologies, ensuring alignment with strategic goals.
• Overseeing provider contract performance audits and remediation strategies in collaboration with actuarial, finance, medical economics, claims operations, and payment integrity teams.
• Monitoring network adequacy and ensuring compliance with federal and state regulations, while identifying and addressing access gaps.
• Conducting ongoing analysis of provider networks from cost, coverage, and growth perspectives to inform strategic expansion decisions.
• Leading provider contract due diligence for network development in expansion markets.
• Serving as a subject matter expert on reimbursement methodologies and educating key operational teams.
• Supporting budgeting and forecasting efforts related to medical trend and unit cost increases.
• Driving contract performance by aligning negotiated rates with budgeted medical cost trends.
• Analyzing claims data and market dynamics to guide strategic contract negotiations.
• Building and maintaining executive-level relationships with provider organizations.
• Collaborating with leaders to grow accretive market share and enhance the value of the health plan through innovative cost-of-care strategies.
• Staying abreast of industry trends, regulatory changes, and emerging care delivery models to continuously refine network strategy.

You Will Be Successful If:

• Knowledgeable of the full continuum of reimbursement methodologies to include fee-for-service, risk sharing, and capitation
• Must possess strong communication skills and be comfortable with public speaking.
• Excellent financial and analytics as well as business acumen and familiarity with the operations of sophisticated large integrated delivery systems, innovative business models, managing of a complex multi-institutional and multi-market environment, joint ventures, and evolving population health and payment models.
• Knowledge of current national health care policies and trends, as well as leadership, management, and quality improvement concepts.

What You Will Bring:

• Bachelors degree or equivalent experience in Business Administration, Healthcare Administration or related field. Masters Degree Preferred.
• 10 years of combined experience in managed care, provider contracting, provider network operations and management, and health plan operations experience.

About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That's Impresiv!