Overview Our client, a leading health plan in the District of Columbia, is seeking an experienced Director, Provider Network & Contracting to oversee value-based care (VBC) strategies, provider contracting, and network development. This leadership role supervises a team of four, negotiates provider reimbursement and incentive-based arrangements, and works to grow a high-quality, cost-efficient provider network. Responsibilities Lead network development, provider recruitment, contracting, and retention initiatives to ensure access to quality, cost-efficient care. Negotiate provider reimbursement rates, contract terms, and alternative payment methodologies (e.g., shared savings, risk sharing, bundled arrangements). Direct the Provider Relations team, including daily operations, hiring, performance evaluations, mentoring, and professional development. Develop and oversee value-based care arrangements and provider pay-for-performance programs. Collaborate with finance, operations, and legal teams to manage all financial, operational, and compliance aspects of provider contracts. Ensure compliance with all state and federal regulatory requirements, including Medicaid and Medicare standards. Oversee the development and implementation of provider education programs and initiatives to strengthen provider engagement. Monitor cost containment initiatives and implement strategies to meet strategic goals. Provide leadership and guidance on complex reimbursement and contracting issues, including APR-DRG hospital reimbursement methodology and claims adjudication. Assess market readiness for network expansion and development in targeted states. Qualifications Education Bachelor’s degree in a related field required Master’s degree in Business or Healthcare Administration preferred Experience 8–10 years of experience in managed care/healthcare, with strong provider contracting and network development expertise 5–7 years of experience with government programs, specifically Medicaid and Medicare Hands-on experience with provider pay-for-performance programs and value-based care reimbursement models Significant experience managing provider networks (primary care and specialty) with focus on access to care 5–7 years of supervisory experience, including direct staff leadership and team development Strong knowledge of APR-DRG hospital reimbursement methodology and claims adjudication systems Skills & Abilities Exceptional negotiation, problem-solving, and decision-making skills Strong financial acumen with proven contracting and data analysis experience Ability to manage multiple projects and priorities effectively Excellent written and verbal communication skills, including formal presentations Proficiency with MS Office (Word, Excel, PowerPoint) and database applications Demonstrated ability to build collaborative provider relationships to support quality and financial initiatives Knowledge of state and federal regulatory requirements, with broad experience in both commercial and government healthcare contracting This position offers a salary up to $180K (no bonus) plus benefits. Relocation support may be available depending on compensation needs.

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