Health Plan Network Strategy Director

Location Address:

Compensation Pay Range:

Minimum Offer $:

Maximum Offer for this position is up to $:

Now hiring a

Summary:

Type of Opportunity:

Job Exempt:

Job is based :

Work Shift:

Responsibilities:

Presbyterian is seeking a Health Plan Network Strategy Director to lead strategic initiatives in provider contracting, network development, and adequacy. This role is responsible for building and maintaining high-level partnerships with provider organizations, ensuring compliance with federal and state regulations, and supporting access and availability standards. The strategist will conduct ongoing cost, coverage, and growth analyses of the provider network and identify opportunities for expansion or optimization to align with health plan goals.

Some key responsibilities include:

• Leading the development and negotiation of high-value provider contracts-exceeding $1B annually-with major hospital systems and provider organizations.

• Owning complex contract modeling and network adequacy technologies, ensuring alignment with strategic goals.

• Overseeing provider contract performance audits and remediation strategies in collaboration with actuarial, finance, medical economics, claims operations, and payment integrity teams.

• Monitoring network adequacy and ensuring compliance with federal and state regulations, while identifying and addressing access gaps.

• Conducting ongoing analysis of provider networks from cost, coverage, and growth perspectives to inform strategic expansion decisions.

• Leading provider contract due diligence for network development in expansion markets.

Qualifications:

• Bachelors degree or equivalent experience in Business Administration, Healthcare Administration or related field. Masters Degree Preferred.

• 10 years of combined experience in managed care, provider contracting, provider network operations and management, and health plan operations experience.

• Knowledgeable of the full continuum of reimbursement methodologies to include fee-for-service, risk sharing, and capitation Must possess strong communication skills and be comfortable with public speaking.

• Excellent financial and analytics as well as business acumen and familiarity with the operations of sophisticated large integrated delivery systems, innovative business models, managing of a complex multi-institutional and multi-market environment, joint ventures, and evolving population health and payment models.

• Knowledge of current national health care policies and trends, as well as leadership, management, and quality improvement concepts.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.