Senior Director, Network Management
On-siteHouston, Texas, United States
Job Summary
Architect and optimize high-performing provider networks for value-based and risk-bearing arrangements across all Apex client markets, with immediate accountability to build the Houston network from the ground up. Lead multi-year network strategy, PCP anchor recruitment, and complex negotiations with medical group presidents to establish proprietary provider relationships. Structure Medicare Advantage risk contracts, IPA, and CIN entities by translating actuarial and MLR economics into contract terms, while standing up governance, credentialing oversight, and analytics infrastructure. Own network cost of care, utilization mix, and leakage through monthly operating reviews and JOCs, ensuring compliance with CMS, TDI, and NCQA standards. Represent Apex in client audits and regulatory examinations, coaching a high-performing team to sustain network performance at scale.
Required Qualifications
- Bachelor's in Healthcare Administration, Business, Finance, Public Health, or related field
- 7+ years of progressive provider network development, contracting, and management within a health plan, IPA, CIN, MSO, ACO, or other risk-bearing entity
- 7+ years leading contracting and/or provider relations teams
- Demonstrated track record standing up or materially expanding a provider network in a new geography — Houston or comparable metro
- Deep experience negotiating and operationalizing Medicare Advantage risk contracts (full/partial cap, global cap, percent-of-premium, delegated)
- Current, working knowledge of MA economics — bid mechanics, benchmark and rebate flow, Star Ratings, HCC/RAF risk adjustment, MLR — and of what constitutes a risk-bearing entity (CMS delegation, DOI solvency/reserves, stop-loss, downstream risk)
- Hands-on experience developing IPA and/or CIN networks: governance, physician alignment economics, and clinical integration
- Travel: 30-50%
Desired Qualifications
- Master's (MHA, MBA, MPH, JD) or equivalent experience in managed care, actuarial, or provider economics
- Existing Houston relationships that can be activated on day one
- Prior role at a top-decile MA health plan, risk-bearing physician platform, or MSSP/ACO REACH participant
- Experience translating actuarial models into contract structure
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.