About this role
This role will partner closely with the VP of Contracting to develop and execute hospital contracting strategies across the organization. The Director will lead negotiations with hospitals, health systems, and facility-based providers, ensuring competitive reimbursement arrangements, network adequacy, and alignment with organizational growth objectives. This individual will serve as a subject matter expert in managed care contracting, hospital reimbursement methodologies, delegated risk arrangements, and complex facility agreements while collaborating with key stakeholders to optimize network performance and financial outcomes. Lead negotiations and ongoing relationship management with hospitals, integrated delivery systems (IDS), academic medical centers, and other facility-based providers. Develop and execute hospital contracting strategies that support network expansion, market competitiveness, affordability, and financial performance. Analyze hospital utilization, reimbursement models, and financial performance to support contract negotiation strategies. Negotiate complex facility agreements, including inpatient, outpatient, behavioral health, post-acute, and ancillary service arrangements. Manage Division of Financial Responsibility (DOFR) agreements, hospital amendments, Letters of Agreement (LOAs), and corrective action plans with health plans and hospital partners. Evaluate contractual language, reimbursement structures, risk allocation provisions, and regulatory requirements to mitigate organizational risk. Serve as the primary contracting escalation point for hospital and health system partners. Collaborate with Finance, Network Management, Operations, Claims, Configuration, and Business Development teams to ensure successful implementation of hospital contract terms. Monitor hospital contract performance, identify opportunities for rate optimization, and address network access or financial performance concerns. Support value-based and risk-sharing initiatives involving hospital systems and facility partners. Prepare analyses and recommendations regarding hospital network strategy, reimbursement trends, financial impact, and market opportunities. Lead and mentor contracting staff while overseeing contract workflow and negotiation priorities. Other duties as assigned.