Job Description Summary
The Network Contracting Lead is a senior-level individual contributor who operates with significant independence and serves as a recognized subject matter expert in provider contracting. Develops, negotiates, and manages complex provider agreements that support CareMore's care delivery model, provider network strategy, and financial and operational objectives. This role ensures access to high-quality, cost-effective healthcare services while supporting value-based care arrangements, regulatory compliance, network adequacy, and strong provider partnerships across CareMore's markets.
The Network Contracting Lead provides strategic expertise in provider reimbursement, process excellence, and network development, with a focus on supporting CareMore's Medicare Advantage populations, coordinated care delivery, and value-based healthcare initiatives. The position partners closely with Finance, Legal, Clinical Leadership, Provider Relations, Market Operations, and executive leadership to develop contracting solutions that improve provider alignment, financial performance, patient access, and quality outcomes.
Operating with a high degree of independence and minimal supervision, the Network Contracting Lead serves as the primary point of accountability for complex network contracting initiatives. The position independently evaluates contracting opportunities, resolves complex provider and reimbursement challenges, and makes strategic recommendations that influence market-level and enterprise-wide network performance.
How will you make an impact & Requirements
Provider Contract Negotiation & Management
- Lead complex provider contract negotiations involving physician groups, specialists, hospitals, ancillary providers, health systems, and other healthcare partners supporting CareMore's care delivery network.
- Develop and execute contracting strategies that support CareMore's clinical model, patient access requirements, network adequacy, financial objectives, and market-specific needs.
- Independently evaluate and negotiate reimbursement terms, contract structures, performance requirements, and value-based arrangements to ensure competitive and sustainable provider partnerships.
- Manage complex contract renewals, amendments, terminations, and renegotiations while minimizing disruption to patient care and provider relationships.
Network Strategy & Development
- Partner with CareMore's market and clinical leadership to evaluate provider network needs, identify service gaps, and develop contracting solutions that improve patient access and continuity of care.
- Support the development and optimization of provider networks aligned with CareMore's coordinated, patient-centered care delivery model.
- Evaluate provider performance, market competitiveness, reimbursement trends, and network adequacy to identify opportunities for network improvement and cost optimization.
- Provide strategic contracting recommendations that support market growth, operational effectiveness, and the long-term sustainability of CareMore's provider network.
Value-Based Care & Reimbursement Strategy
- Develop and negotiate provider agreements that support value-based care, quality improvement, cost management, and coordinated care delivery.
- Evaluate reimbursement methodologies, including fee-for-service, capitation, shared savings, risk-based arrangements, and other alternative payment models, as applicable.
- Partner with Finance and Clinical Leadership to assess the financial and operational implications of proposed contracting arrangements.
- Support contracting strategies that promote appropriate utilization, improved clinical outcomes, and effective management of total cost of care.
Cross-Functional Partnership & Strategic Advisory
- Serve as a primary contracting advisor to CareMore's senior leadership, providing expertise on complex negotiations, reimbursement strategies, provider economics, and network development.
- Collaborate with Finance, Legal, Clinical Operations, Provider Relations, Credentialing, and Market Leadership to resolve complex contracting and provider-related issues.
- Present contracting recommendations, financial analyses, negotiation strategies, and identified risks to senior leadership to support informed business decisions.
Contracting Performance & Compliance
- Analyze provider reimbursement, contract performance, utilization trends, and financial outcomes to identify opportunities for improved network effectiveness.
- Ensure contracting activities comply with applicable federal and state regulations, Medicare Advantage requirements, organizational policies, and contractual obligations.
- Partner with Legal and Compliance to identify and mitigate contracting risks, including reimbursement disputes, contract interpretation issues, and regulatory concerns.
- Support accurate contract documentation, implementation, and ongoing administration in coordination with internal stakeholders.
Contracting Leadership & Continuous Improvement
- Serve as a recognized subject matter expert in provider contracting, reimbursement methodologies, negotiation strategy, and managed care network development.
- Develop and recommend contracting standards, negotiation frameworks, financial models, and best practices to improve consistency, efficiency, and effectiveness across CareMore's markets.
- Provide technical guidance and expertise to contracting professionals and cross-functional partners on complex negotiations and provider contracting issues.
- Proactively identify emerging market trends, reimbursement challenges, and opportunities to strengthen CareMore's provider partnerships and network strategy.
Compensation Range:
$130,159.00
to
$195,238.00
The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.
