MedStar Health · 2 months ago
Director, Provider Relations, Strategy & Network Contracting
Washington, DC
Contract
Onsite
Director/Executive
8+ years expMedStar Health is a healthcare organization that provides comprehensive provider relations management. The role involves overseeing provider relations, negotiating reimbursement rates, and implementing value-based care strategies to ensure a quality and cost-efficient provider network in the District of Columbia.
Health CareMedical
Responsibilities
Manages Provider Relations department to include day to day operations, hiring and performance evaluations. Assists in development and growth in essential job functions and performance standards. Includes development and monitoring of performance metrics and goals for the provider relations team in collaboration with the MedStar Family Choice District of Columbia leadership team. Provides guidance on development performance and productivity. Recommends changes to improve efficiency and effectiveness
With guidance develops and expands MedStar Family Choice's Value- Based Care program by partnering with health care systems within DC and Maryland; implement programs and strategies related to manage care contracts
Leads, develops and implements alternative payment methodologies (shared savings risk sharing bundle arrangements)
Manages the oversight of network development recruitment contracting and retention activities
Develops contract negotiation strategy to meet Strategic Goals. Collaborates with key stakeholders including finance health plan leaders, operations and legal to manage financial and operational and legal provisions of the contracts. Implement contracting processes to effectively manage and maintain contract proposal renewals and analysis contract execution and configuration
Assesses market readiness in targeted states for network development and expansion
Ensures compliance with state and federal regulatory requirements related to applicable state laws
Provides supervision and mentoring of Provider Relations and contracting team
Qualification
Required
Bachelor's degree in related field required
8-10 years' experience in managed care/health care required and knowledge of government programs with a specific focus on Medicaid
APR-DRG hospital reimbursement methodology and claims adjudication systems is required
Significant experience managing networks and provider relations for primary care and specialty practices with a focus on access to care is required
5-7 years' experience in supervisory capacity is required
Strong analytical skills
Strong written and verbal communication skills and experience with formal presentations
Superior problem-solving decision making and negotiation skills
Ability to prioritize and managed multiple projects
Proficiency with word processing database spreadsheet programs and database applications
Work requires demonstrated experience in the managed care environment, such as an Integrated Medical System in an administrative or finance setting or managed care organization/Insurance Company
Must have analytical and strong financial skills contracting knowledge
Must have experience with data analysis and statistics
Requires proven experience engaging providers in meaningful dialogue that results in collaborative relationships to support quality and financial initiatives
Knowledge of complex managed care concepts including provider recruitment network development and managed care contractual process; including alternative reimbursement models associated with incentive and risk-based programs
Demonstrated knowledge of value-based care reimbursement models
Healthcare contract experience in commercial and government contracting
Knowledge of multi-state and federal regulatory requirements
Broad contracting experience in unregulated markets
Preferred
Master's degree in business or in health care administration preferred
5-7 years' experience with state and federal programs such as Medicaid and Medicare is beneficial
Experience with provider pay-for-performance programs preferred
Company
MedStar Health
MedStar Health is a not-for-profit healthcare organization
10001+ employees
H1B Sponsorship
MedStar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (13)
2023 (14)
2022 (14)
2021 (12)
2020 (14)
Funding
Current Stage
Late StageTotal Funding
$29MKey Investors
American Medical AssociationAgency for Healthcare Research and QualityA. James and Alice B. Clark Foundation
2023-06-21Grant
2022-09-27Grant· $2M
2020-07-03Grant· $27M
Leadership Team
David Mayer
Executive Director MedStar Institute for Quality and Safety Quality and Safety CEO Patient Safety Mo
Recent News
2025-12-17
Maryland Daily Record
2025-12-05
Company data provided by crunchbase