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CINQCARE · 19 hours ago

Regional Director Provider Network Management (Northeast)

New York, NY

Full-time

Onsite

Director/Executive

$155K/yr - $175K/yr

7+ years exp

CINQCARE is a provider-led, community-based health and care partner dedicated to improving health and well-being. The Director, Provider Network Management is responsible for leading provider network strategy and management across the northeast region, focusing on driving practice profitability and ensuring robust network growth.

CommunitiesHealth CareHome Health CareMedical

Responsibilities

Oversee the strategic development and expansion of CINQCARE's provider network in the northeast 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 incentive

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

Lead financial oversight of the northeast regional 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)

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

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

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

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 northeast region growth in high-needs communities while prioritizing profitability

Qualification

Healthcare network managementFinanceRevenue cycle managementValue-based contractingFinancial modelingData analyticsContract negotiationMicrosoft Office SuiteLeadership skillsCommunication skillsProblem-solving skillsStrategic thinking

Required

Bachelor's degree in healthcare administration, business, finance, or a related field; advanced degree (e.g., MBA, MHA, or MPH) required

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 understanding concepts of 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 northeast communities

Advanced financial acumen with deep knowledge of healthcare economics, reimbursement methodologies (e.g., fee-for-service, capitation, shared savings), and value-based care principles, with a focus on profitability

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