MetroPlusHealth
Join to apply for the Senior Director of Provider Contracting role at MetroPlusHealth.
Base pay range $200,000.00/yr - $214,000.00/yr
Position Overview MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You will support the Vice President of Provider Contracting and Value-Based Partnerships by providing administrative and management support necessary to achieve the organization’s goals related to a comprehensive, cost‑efficient and accessible provider network that is contracted and linked to appropriate fee schedules. You will also serve as the organization’s senior leadership liaison on contracting matters with all departments involved in contracting processes.
Scope of Role & Responsibilities
Negotiate contracts and manage relationships with participating hospitals, IPAs, ambulatory surgery centers, SUD sites, behavioral health providers, urgent care facilities, physician groups, and key specialty providers (e.g., optometry).
Help develop both the short‑ and long‑term network and contracting strategies for the Plan.
Ensure end‑to‑end contracting process, including outreach, recruitment, contract initiation, amendment mailings, and provider non‑renewals and terminations.
Develop, with Executive Leadership, a comprehensive value‑based payment strategy with key provider partners.
Coordinate with the Director of Credentialing and the Credentialing Department.
Coordinate with the Director of Provider Data Management and the Provider Maintenance Department.
Coordinate with the Director of Special Investigations Unit and the SIU Department.
Negotiate and review all existing and proposed hospital and large provider contracts, ensuring competitive reimbursement and identifying cost‑saving opportunities for MetroPlusHealth.
Manage both physical and behavioral health provider networks, ensuring adequacy and competitive payment that meets regulatory guidance.
Coordinate network development and contracting strategy as MetroPlusHealth expands into new lines of business.
Work with legal to review and modify negotiated provider contract language as necessary.
Manage an out‑of‑network strategy addressing high‑cost out‑of‑network cases, primarily for commercial and exchange products.
Manage the process for single case agreements and work closely with legal and regulatory on independent dispute resolution processes.
Supervise a team of senior directors, directors, and managers and manage the budget for the entire department.
Support the development of policies and strategic direction for expanding a comprehensive network.
Work with finance and analytics & reporting departments on rate development and related activities, evaluating reimbursement structures and cost‑containment initiatives.
Work with analytics & reporting and reimbursement teams to address all contract‑monitoring activities, ensuring provider compliance with contract terms and conditions.
Collaborate with MetroPlusHealth departments to develop and evaluate proposals for operational improvements and new products, recommending improvements in performance and cost effectiveness.
Assist sales and provider network operations departments in directing and maintaining provider relationships through education and provider relations efforts, including marketing initiatives to promote membership growth.
Perform other related functions as required.
Required Education, Training & Professional Experience
Master’s Degree in Business, Health Care Administration, or related field, required.
Minimum of 7–10 years senior management experience in contracting, including a minimum of 5 years managed‑care contract leadership experience in New York State.
Proven ability to achieve the organization’s missions, goals, and objectives or an equivalent combination of education and experience.
Licensure And/or Certification Required
None
Professional Competencies
Integrity and trust
Customer focus
Functional/technical skills
Written/oral communication
Seniority level Executive
Employment type Full‑time
Job function Health Care Provider
Industries Hospitals and Health Care
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Base pay range $200,000.00/yr - $214,000.00/yr
Position Overview MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You will support the Vice President of Provider Contracting and Value-Based Partnerships by providing administrative and management support necessary to achieve the organization’s goals related to a comprehensive, cost‑efficient and accessible provider network that is contracted and linked to appropriate fee schedules. You will also serve as the organization’s senior leadership liaison on contracting matters with all departments involved in contracting processes.
Scope of Role & Responsibilities
Negotiate contracts and manage relationships with participating hospitals, IPAs, ambulatory surgery centers, SUD sites, behavioral health providers, urgent care facilities, physician groups, and key specialty providers (e.g., optometry).
Help develop both the short‑ and long‑term network and contracting strategies for the Plan.
Ensure end‑to‑end contracting process, including outreach, recruitment, contract initiation, amendment mailings, and provider non‑renewals and terminations.
Develop, with Executive Leadership, a comprehensive value‑based payment strategy with key provider partners.
Coordinate with the Director of Credentialing and the Credentialing Department.
Coordinate with the Director of Provider Data Management and the Provider Maintenance Department.
Coordinate with the Director of Special Investigations Unit and the SIU Department.
Negotiate and review all existing and proposed hospital and large provider contracts, ensuring competitive reimbursement and identifying cost‑saving opportunities for MetroPlusHealth.
Manage both physical and behavioral health provider networks, ensuring adequacy and competitive payment that meets regulatory guidance.
Coordinate network development and contracting strategy as MetroPlusHealth expands into new lines of business.
Work with legal to review and modify negotiated provider contract language as necessary.
Manage an out‑of‑network strategy addressing high‑cost out‑of‑network cases, primarily for commercial and exchange products.
Manage the process for single case agreements and work closely with legal and regulatory on independent dispute resolution processes.
Supervise a team of senior directors, directors, and managers and manage the budget for the entire department.
Support the development of policies and strategic direction for expanding a comprehensive network.
Work with finance and analytics & reporting departments on rate development and related activities, evaluating reimbursement structures and cost‑containment initiatives.
Work with analytics & reporting and reimbursement teams to address all contract‑monitoring activities, ensuring provider compliance with contract terms and conditions.
Collaborate with MetroPlusHealth departments to develop and evaluate proposals for operational improvements and new products, recommending improvements in performance and cost effectiveness.
Assist sales and provider network operations departments in directing and maintaining provider relationships through education and provider relations efforts, including marketing initiatives to promote membership growth.
Perform other related functions as required.
Required Education, Training & Professional Experience
Master’s Degree in Business, Health Care Administration, or related field, required.
Minimum of 7–10 years senior management experience in contracting, including a minimum of 5 years managed‑care contract leadership experience in New York State.
Proven ability to achieve the organization’s missions, goals, and objectives or an equivalent combination of education and experience.
Licensure And/or Certification Required
None
Professional Competencies
Integrity and trust
Customer focus
Functional/technical skills
Written/oral communication
Seniority level Executive
Employment type Full‑time
Job function Health Care Provider
Industries Hospitals and Health Care
#J-18808-Ljbffr