Our Company
Abilis Health Plan
Overview
The Dir of Contracting & Network Management is a leadership role responsible for developing, negotiating, and managing provider contracts and networks for the health plan. This leader ensures that provider networks are adequate, efficient, financially sustainable, and aligned with the organization's strategic goals (e.g., value-based care, member access, cost containment). The role combines strategy, operations, regulatory compliance, provider relationships, analytics, and financial oversight.
Responsibilities
Key Responsibilities
Network Strategy & Design
- Develop, lead and execute provider network strategies to ensure sufficient access across specialties and geographies.
- Evaluate market trends, competitor networks, member needs, and regulatory requirements.
- Identify network adequacy gaps (geographic, specialty, quality) and develop plans to close them.
Contracting & Negotiations
- Negotiate contracts with hospitals, physician groups, ancillary providers, and facility partners.
- Manage contract lifecycle: drafting, reviewing, executing, renewing, amending, termination.
- Structure payment/reimbursement models, including fee‐for‐service, capitation, bundled payments, shared savings, etc.
- Ensure terms in contracts align with financial targets, risk tolerances, quality goals, and regulatory obligations.
Provider Relations & Network Management
- Maintain and strengthen relationships with providers; serve as point of escalation for issues.
- Oversee provider data integrity, delegation oversight, and provider performance.
- Facilitate provider satisfaction, addressing service or payment concerns.
- Support provider onboarding, education around contract terms, and performance expectations.
Operational Oversight & Compliance
- Lead operational functions such as network administration, provider directory maintenance, delegation oversight.
- Ensure network adequacy meets federal/state regulatory requirements.
- Oversee policies, procedures, and systems to track and govern contracting and network operations.
- Coordinate with legal, finance, compliance, claims, member services, and other stakeholders.
Value-Based Care & Cost Management
- Lead or support the development of value‐based contracting models
- Work with analytics team to develop monitoring for utilization, cost trends, provider performance, and identify improvement opportunities.
- Develop reimbursement strategies that balance cost, access, quality, and provider incentives.
Financial Management & Analytics
- Develop and manage budgets for network and contracting functions.
- Forecast network costs, provider reimbursements; assess financial impacts of different contracting strategies.
- Monitor medical loss ratio (MLR) and other cost drivers associated with provider contracts.
Leadership & Team Management
- Build, lead, mentor, and manage a high performing team spanning contracting, provider relations, network operations, and other cross functional teams for implementation.
- Set goals, provide feedback, drive accountability.
- Foster a culture of collaboration, continuous improvement, and responsiveness.
Stakeholder Engagement & Internal Collaboration
- Serve on senior leadership teams; align network & contracting strategy with organizational objectives.
- Collaborate with product development, sales, marketing to ensure network adequacy supports product offerings.
- Coordinate with utilization management, quality, member services, clinical, legal, and regulatory affairs.
Regulatory & Industry Monitoring
- Stay current on relevant state and federal regulations (e.g., network adequacy, reimbursement law)
- Monitor trends in managed care, payer/provider innovations, competitive market shifts.
- Adapt strategies to evolving regulatory requirements and market conditions.
Qualifications
Bachelor's degree preferred or related years of contracting and leadership experience
Experience:
- At least 5 years of experience in managed care, health plan operations, provider contracting, or network management.
- Proven progress from operational to strategic leadership roles.
- Prior experience negotiating complex provider contracts (hospital systems, physician groups, ancillary providers).
- Experience with value-based contracting, risk sharing, capitation, bundled payments, shared savings, etc.
- Demonstrated ability to manage and develop teams.
Skills & Knowledge:
- Strong financial acumen; ability to model cost/reimbursement scenarios.
- Excellent negotiation, communication, and relationship building skills.
- Ability to use data/analytics to drive decision making.
- Knowledge of regulatory requirements (state/federal), accreditation standards, network adequacy requirements.
- Change management, strategy implementation, cross-functional leadership.
About our Line of Business
Abilis Health Plan, an affiliate of BrightSpring Health Services, is a Medicare Advantage Plan covering all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). The Abilis Health Plan is a unique plan allowing members to enroll year-round. The plan focuses on members who meet residential requirements in participating nursing facilities. An interdisciplinary team of clinicians and innovative services allow us to meet each member's clinical needs and provide preventive, coordinated, and quality healthcare. With a dedicated nurse practitioner leading a personalized care plan, we strive to improve the health of the communities in which we serve. For more information, please visit www.abilishealth.com. Follow us on LinkedIn.
Salary Range
USD $130,000.00 - $150,000.00 / Year