Director Provider Contracting

This job is responsible for directing negotiation of the plan’s key contracts with health care providers, overseeing financial analyses, and implementing network contract and reimbursement initiatives.

Requirements

• Direct and oversee hospital and institutional provider contract negotiations
• Negotiate rates for nonparticipating provider services
• Manage the design and implementation of provider strategies and reimbursement methodologies
• Develop strategic relationships with key provider constituents
• Engage with external consultants as needed
• Prepare expansion requests for regulatory agencies
• Oversee the production of provider directories and reviews Access & Availability studies
• Facilitate and oversee CACTUS credentialing database functionality