CINQCARE
Regional Director, Provider Network Management (Central) - 0575
CINQCARE, Chicago, Illinois, United States, 60290
Regional Director, Provider Network Management (Central) - 0575
Position Overview The Central Regional Director, Provider Network Management is a director-level position responsible for leading provider network strategy, development, and management across CINQCARE's central region. The role focuses on driving practice profitability through strategic provider partnerships and optimized financial performance. Executive contact for network providers participating in programs such as ACO REACH, Medicare Shared Savings Program (MSSP), and payer value-based care arrangements. The ideal candidate possesses advanced expertise in finance, revenue cycle management (RCM), and value-based contracting, with a proven ability to enhance profitability while fostering high-level provider relationships and achieving regional performance goals. Key Responsibilities
Strategic Network Leadership & Development Oversee strategic development and expansion of CINQCARE’s provider network in the central region, recruiting primary care practices, FQHCs, specialty groups such as IPAs and PLEs, and building preferred provider networks to support ACO REACH, MSSP, and payer value-based care programs, prioritizing profitability. Conduct regional network gap analyses to identify opportunities for meeting recruitment targets and budgeted revenue through cost-effective growth, ensuring geographic coverage, and service accessibility in underserved communities while optimizing financial returns. Lead initiatives to integrate value-based contracting models that drive profitability through shared savings, risk-sharing, gain sharing and performance-based incentives. Executive Provider Engagement Serve as the primary executive contact for network providers, leading high-level discussions on program participation, contract terms, profitability goals, and strategic alignment across ACO REACH, MSSP, and payer value-based care arrangements. Build and maintain executive relationships with provider leaders, educating them on CINQCARE’s value-based care frameworks, profitability-driven quality incentives, and profitability goals. Resolve complex provider issues, negotiate escalations, and promote collaboration to maximize financial performance and community impact. Finance and Revenue Cycle Management (RCM) Lead financial oversight of the central regional provider network, managing profit and loss (P&L) responsibilities at the provider level, budgeting, and forecasting to ensure maximum profitability and sustainability of value-based programs. Optimize RCM processes within provider contracts, overseeing claims adjudication (fee reduced claims), reimbursement strategies, and revenue optimization to eliminate leakage and drive revenue growth. Collaborate with finance and HCE teams to analyze regional financial data, implement cost-saving measures, and develop performance-based incentives that enhance profitability while maintaining quality and other performance metrics (e.g., risk adjustment). Contract Negotiation and Value-Based Contracting Direct contract negotiations for fee-for-service, capitation, shared savings, and risk-sharing arrangements, leveraging advanced financial modeling to prioritize profitability and mitigate risks. Ensure contracts comply with CMS regulations for ACO REACH and MSSP, as well as payer-specific value-based care requirements, while aligning with CINQCARE’s profitability objectives. Partner with legal, compliance, and finance teams to draft and amend terms that maximize financial outcomes and support regional growth strategies. Performance Monitoring and Reporting Monitor regional provider performance against financial, quality, and equity benchmarks, using advanced analytics to drive profitability through improved care delivery and cost efficiency. Prepare executive-level reports on network performance, profitability metrics, and program compliance for CINQCARE leadership, CMS, and payer stakeholders. Leverage financial insights to recommend strategic adjustments, ensuring sustained P&L growth and value-based program success. Regulatory and Compliance Leadership Maintain expert knowledge of CMS guidelines for ACO REACH and MSSP, payer value-based care trends, and federal regulations, including Stark Law, Anti-Kickback Statute, and HIPAA, to ensure compliance while optimizing profitability. Ensure all regional activities promote compliance, adapting to industry changes to sustain program integrity and financial performance. Cross-Functional and Team Leadership Collaborate with market presidents, clinical, quality, finance, and HCE teams to align network strategies with CINQCARE’s profitability and clinical goals. Mentor and lead a team of network management/recruitment professionals, fostering a culture of financial accountability and innovation. Contribute to enterprise-wide strategic planning for network expansion, with a focus on central region growth in high-needs communities while prioritizing profitability. Required Qualifications
Education Bachelor’s degree in healthcare administration, business, finance, or a related field; advanced degree (e.g., MBA, MHA, or MPH) required. Experience 7+ years in healthcare network management, provider contracting, or regional leadership, with at least 3 years in a director-level or equivalent role. Extensive experience in finance, including P&L management, financial modeling, budgeting, and forecasting, with a focus on driving profitability in healthcare programs. Expertise in revenue cycle management (RCM) encompassing claims processing, reimbursement optimization, denial management, and revenue integrity. Demonstrated success in value-based contracting, preferably with ACO REACH, MSSP, or payer value-based care arrangements, with a track record of improving profitability. Track record of serving as an executive contact for providers in value-based or Medicare programs, ideally in underserved central communities. Skills & Competencies Advanced financial acumen with deep knowledge of healthcare economics, reimbursement methodologies, and value-based care principles. Strong leadership and negotiation skills to manage executive-level provider relationships and coordinate regional teams. Proficiency in data analytics for financial performance, RCM optimization, and profitability-driven network strategy. In-depth familiarity with CMS regulations for ACO REACH and MSSP, as well as payer contracting. Proficient in Microsoft Office Suite, financial software, and CRM systems. Exceptional communication, problem-solving, and strategic thinking skills with a passion for relationship management and profitability. Our Benefits
Medical Plans: Two comprehensive options offered to Team members. 401(k) – 4% employer match. Dental & Vision: Flexible plans with in-network savings. Paid Time Off: Generous PTO, holidays and wellness time. Extras: Pet insurance, commuter benefits, mileage reimbursement, CME for providers, and company‑provided phones for field staff. Working Environment & Physical Requirements
In‑office work performed indoors in a traditional office setting with conditioned air, artificial light, and an open workspace. Regular use of the telephone and e‑mail for communication essential. Sitting for extended periods common. Lifting up to 10 lbs. occasionally required. Good manual dexterity for common office equipment, good reasoning ability, and ability to understand and utilize management reports and documents to conduct business. Equal Opportunity & Reasonable Accommodation Statement
CINQCARE is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law. If you require a reasonable accommodation during the application or employment process, please indicate this in your application or speak with your recruiter during the hiring process. Disclaimer
This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary. Compensation
From $155,000 to $175,000 per year
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Position Overview The Central Regional Director, Provider Network Management is a director-level position responsible for leading provider network strategy, development, and management across CINQCARE's central region. The role focuses on driving practice profitability through strategic provider partnerships and optimized financial performance. Executive contact for network providers participating in programs such as ACO REACH, Medicare Shared Savings Program (MSSP), and payer value-based care arrangements. The ideal candidate possesses advanced expertise in finance, revenue cycle management (RCM), and value-based contracting, with a proven ability to enhance profitability while fostering high-level provider relationships and achieving regional performance goals. Key Responsibilities
Strategic Network Leadership & Development Oversee strategic development and expansion of CINQCARE’s provider network in the central region, recruiting primary care practices, FQHCs, specialty groups such as IPAs and PLEs, and building preferred provider networks to support ACO REACH, MSSP, and payer value-based care programs, prioritizing profitability. Conduct regional network gap analyses to identify opportunities for meeting recruitment targets and budgeted revenue through cost-effective growth, ensuring geographic coverage, and service accessibility in underserved communities while optimizing financial returns. Lead initiatives to integrate value-based contracting models that drive profitability through shared savings, risk-sharing, gain sharing and performance-based incentives. Executive Provider Engagement Serve as the primary executive contact for network providers, leading high-level discussions on program participation, contract terms, profitability goals, and strategic alignment across ACO REACH, MSSP, and payer value-based care arrangements. Build and maintain executive relationships with provider leaders, educating them on CINQCARE’s value-based care frameworks, profitability-driven quality incentives, and profitability goals. Resolve complex provider issues, negotiate escalations, and promote collaboration to maximize financial performance and community impact. Finance and Revenue Cycle Management (RCM) Lead financial oversight of the central regional provider network, managing profit and loss (P&L) responsibilities at the provider level, budgeting, and forecasting to ensure maximum profitability and sustainability of value-based programs. Optimize RCM processes within provider contracts, overseeing claims adjudication (fee reduced claims), reimbursement strategies, and revenue optimization to eliminate leakage and drive revenue growth. Collaborate with finance and HCE teams to analyze regional financial data, implement cost-saving measures, and develop performance-based incentives that enhance profitability while maintaining quality and other performance metrics (e.g., risk adjustment). Contract Negotiation and Value-Based Contracting Direct contract negotiations for fee-for-service, capitation, shared savings, and risk-sharing arrangements, leveraging advanced financial modeling to prioritize profitability and mitigate risks. Ensure contracts comply with CMS regulations for ACO REACH and MSSP, as well as payer-specific value-based care requirements, while aligning with CINQCARE’s profitability objectives. Partner with legal, compliance, and finance teams to draft and amend terms that maximize financial outcomes and support regional growth strategies. Performance Monitoring and Reporting Monitor regional provider performance against financial, quality, and equity benchmarks, using advanced analytics to drive profitability through improved care delivery and cost efficiency. Prepare executive-level reports on network performance, profitability metrics, and program compliance for CINQCARE leadership, CMS, and payer stakeholders. Leverage financial insights to recommend strategic adjustments, ensuring sustained P&L growth and value-based program success. Regulatory and Compliance Leadership Maintain expert knowledge of CMS guidelines for ACO REACH and MSSP, payer value-based care trends, and federal regulations, including Stark Law, Anti-Kickback Statute, and HIPAA, to ensure compliance while optimizing profitability. Ensure all regional activities promote compliance, adapting to industry changes to sustain program integrity and financial performance. Cross-Functional and Team Leadership Collaborate with market presidents, clinical, quality, finance, and HCE teams to align network strategies with CINQCARE’s profitability and clinical goals. Mentor and lead a team of network management/recruitment professionals, fostering a culture of financial accountability and innovation. Contribute to enterprise-wide strategic planning for network expansion, with a focus on central region growth in high-needs communities while prioritizing profitability. Required Qualifications
Education Bachelor’s degree in healthcare administration, business, finance, or a related field; advanced degree (e.g., MBA, MHA, or MPH) required. Experience 7+ years in healthcare network management, provider contracting, or regional leadership, with at least 3 years in a director-level or equivalent role. Extensive experience in finance, including P&L management, financial modeling, budgeting, and forecasting, with a focus on driving profitability in healthcare programs. Expertise in revenue cycle management (RCM) encompassing claims processing, reimbursement optimization, denial management, and revenue integrity. Demonstrated success in value-based contracting, preferably with ACO REACH, MSSP, or payer value-based care arrangements, with a track record of improving profitability. Track record of serving as an executive contact for providers in value-based or Medicare programs, ideally in underserved central communities. Skills & Competencies Advanced financial acumen with deep knowledge of healthcare economics, reimbursement methodologies, and value-based care principles. Strong leadership and negotiation skills to manage executive-level provider relationships and coordinate regional teams. Proficiency in data analytics for financial performance, RCM optimization, and profitability-driven network strategy. In-depth familiarity with CMS regulations for ACO REACH and MSSP, as well as payer contracting. Proficient in Microsoft Office Suite, financial software, and CRM systems. Exceptional communication, problem-solving, and strategic thinking skills with a passion for relationship management and profitability. Our Benefits
Medical Plans: Two comprehensive options offered to Team members. 401(k) – 4% employer match. Dental & Vision: Flexible plans with in-network savings. Paid Time Off: Generous PTO, holidays and wellness time. Extras: Pet insurance, commuter benefits, mileage reimbursement, CME for providers, and company‑provided phones for field staff. Working Environment & Physical Requirements
In‑office work performed indoors in a traditional office setting with conditioned air, artificial light, and an open workspace. Regular use of the telephone and e‑mail for communication essential. Sitting for extended periods common. Lifting up to 10 lbs. occasionally required. Good manual dexterity for common office equipment, good reasoning ability, and ability to understand and utilize management reports and documents to conduct business. Equal Opportunity & Reasonable Accommodation Statement
CINQCARE is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law. If you require a reasonable accommodation during the application or employment process, please indicate this in your application or speak with your recruiter during the hiring process. Disclaimer
This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary. Compensation
From $155,000 to $175,000 per year
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