HJ Staffing · 1 month ago
Health Plan Network Strategy Director
United States
Full-time
Remote
Director/Executive
10+ years expHJ Staffing is seeking a Health Plan Network Strategy Director to spearhead strategic initiatives in provider contracting, network development, and adequacy. This executive-level role is responsible for building high-value partnerships with major provider organizations and managing a contract portfolio exceeding $1B annually.
Staffing & Recruiting
No H1B
U.S. Citizen Only
Responsibilities
Lead negotiations for high-value provider contracts with major hospital systems; own complex contract modeling and network adequacy technologies
Oversee contract performance audits and remediation strategies, collaborating with Actuarial, Finance, and Medical Economics teams
Monitor and ensure compliance with federal and state regulations, proactively identifying and closing access gaps
Lead due diligence for network development in expansion markets and identify opportunities for optimization
Align negotiated rates with budgeted medical cost trends and support forecasting for unit cost increases
Analyze claims data and market dynamics to guide contract negotiations and enhance "cost-of-care" strategies
Build and maintain executive-level relationships with integrated delivery systems and provider organizations
Qualification
Required
10+ years of combined experience in managed care, provider contracting, network operations, and health plan operations
Bachelor's degree in Business, Healthcare Administration, or a related field
Direct experience within a Health Plan or Managed Care Organization
Experience with Jiva and HRP
Deep knowledge of reimbursement methodologies, including fee-for-service, risk sharing, and capitation
Candidates must reside in one of the following states: NM, CA, IL, ND, NY, OH, WA, or WY
Candidates must be a US Citizen or Green Card holder
Preferred
Master's Degree
Experience with Jiva and HRP is a significant plus
Company
HJ Staffing
HJ Staffing is a certified Employment Agency, and a Women Owned Minority Business Enterprise (WMBE).
11-50 employees
Funding
Current Stage
Early StageLeadership Team
Constance Jones, MSHRM
President & CEO
Company data provided by crunchbase