HJ Staffing

Providing the highest level of professional personnel solutions and placing top talent to all organizations.

Health Plan Network Strategy Director

StrategyStrategyFull TimeRemoteTeam 11-50Since 2016H1B No SponsorCompany SiteLinkedIn

Location

California + 7 moreAll locations: California, Illinois, New Mexico, New York, North Dakota, Ohio, Washington, Wyoming

Posted

10 days ago

Salary

Not specified

Bachelor Degree10 yrs expEnglish

Job Description

• 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.

Job Requirements

  • 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 (Master’s Degree preferred).
  • Direct experience within a Health Plan or Managed Care Organization is required.
  • Experience with Jiva and HRP is a significant plus.
  • Deep knowledge of reimbursement methodologies, including fee-for-service, risk sharing, and capitation.

Related Categories

Related Job Pages

More Strategy Jobs

Customer Insights & Strategy Manager

Dropbox

Dropbox is the one place to keep life organized and keep work moving.

Strategy10 days ago
Full TimeRemoteTeam 1,001-5,000Since 2007H1B Sponsor

The role involves translating customer feedback into actionable insights, developing frameworks for customer satisfaction metrics, and collaborating with cross-functional teams to influence business strategies.

Bi ToolsExcelSQL
United States
$143.8K - $194.6K / year

Principal - Credit Risk Strategy

Toast

We empower the restaurant community to delight guests, do what they love, and thrive.

Strategy10 days ago
Full TimeRemoteTeam 1,001-5,000Since 2013H1B Sponsor

This role involves leading the design and execution of the credit risk strategy across multiple lending products and lifecycle stages, while also partnering with cross-functional teams to launch and scale new lending products responsibly. The individual will build and enhance risk models, perform deep-dive portfolio analyses, and ensure alignment with regulatory requirements.

United States
$112K - $179K / year
Full TimeRemote

As an Associate Director, Digital Strategy, you will support large B2B client engagements, shaping full-funnel paid media strategies that drive pipeline impact and revenue outcomes. This role is for you if you thrive in building strategic partnerships with growth-oriented B2B cli...

United States

Campaign Strategy Lead

Sedgwick

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance

Strategy10 days ago
Full TimeRemoteTeam 10,001+H1B Sponsor

The Campaign Strategy Lead guides the development and execution of full-funnel, integrated marketing campaigns across owned, earned, and paid media channels to drive audience engagement and pipeline growth. This involves owning end-to-end strategy, developing integrated campaign plans, and leading execution across various digital channels.

United States