Sr. Director - Provider Contracting

Description

What You'll Do

• 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
• Other duties as assigned

Qualifications

• Master’s degree and/or Bachelor’s degree or BS/BA in business administration or health care related field of study or equivalent years of experience
• At least 7 years of healthcare contracting experience, including significant experience in hospital contracting
• Experience with managed care, global risk, and risk-based provider contracting arrangements, including RKK-related contracting models
• Demonstrated success negotiating complex provider agreements and managing strategic provider relationships
• Strong understanding of healthcare reimbursement methodologies, network development, and value-based contracting principles

• 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

• Our 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.