Lead Director, Network Management (Oklahoma)
$100,000–$231,540 year
On-siteOklahoma, United States or Oklahoma City, Oklahoma, United States
Job Summary
Manage provider network development by designing conceptual models, negotiating high-value contracts with complex national and regional groups, and executing dispute resolutions to maintain network adequacy. Lead cost arrangements and reimbursement modeling activities while collaborating cross-functionally to implement strategic network configurations and value-based relationships. Recruit providers to meet expansion targets, optimize provider compensation and pricing, and resolve escalated contract interpretation issues in alignment with federal, state, and NCQA regulations. Mentor junior staff on credentialing standards and regulatory compliance.
Required Qualifications
- 10+ years of related healthcare contracting experience
- expert-level negotiation skills
- proven track record of successfully negotiating contracts with large, complex national providers and vendor organizations
- 2+ years of people leadership experience
- demonstrated ability to lead, develop, and influence high-performing teams
- Strong knowledge of provider financial management
- competitive market strategies
- complex contracting methodologies
- value-based and risk-based arrangements
- applicable regulatory requirements
- Demonstrated success identifying and leading initiatives that improve total cost of care
- enhance quality outcomes
- drive organizational performance
- Extensive experience within a health plan, payer, or provider system environment
- deep understanding of healthcare delivery and reimbursement models
- Bachelor's Degree
Desired Qualifications
- Experience with Medicaid regulatory requirements
- demonstrated knowledge of compliance standards
- state-specific program guidelines
- Strong background in Medicaid provider contracting
- Medicaid provider contracting and implementation
- contract development
- negotiations
- network setup activities
- Excellent communication skills
- critical thinking
- problem-solving
- interpersonal skills
- ability to collaborate effectively across cross-functional teams and stakeholders
- Hands-on experience configuring and maintaining provider and vendor contracts within core Aetna Medicaid systems
- including QNXT
- Direct experience working with providers in Oklahoma
- understanding of the state's Medicaid market
- provider landscape
- Working knowledge of value-based care
- alternative payment arrangements
- value-based contracting principles
- performance-based reimbursement models
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