Director Provider Contracting & Relations

How You Will Contribute Provider Contracting Strategy & Negotiation Lead development and execution of provider contracting strategies across markets and provider types, balancing cost, access, quality, network competitiveness, and long-term sustainability. Lead and support complex, high-impact negotiations with health systems and other provider partners, including contract renewals, reimbursement arrangements, amendments, new market opportunities, and escalated contractual issues.

Develop negotiation strategies, objectives, financial parameters, and trade-off scenarios using market intelligence, contract performance, utilization trends, and organizational priorities. Evaluate reimbursement methodologies and contract terms, including fee schedules, percent-of-charge arrangements, case rates, bundled arrangements, value-based models, and other alternative payment structures. Identify contractual, financial, operational, and relationship risks; develop recommendations and escalation strategies to support informed decision-making.

Ensure executed agreements and negotiated terms are clearly documented, operationally feasible, and effectively transitioned to the teams responsible for implementation and ongoing administration. Provider Relationships & Network Performance Build and maintain productive, long-term relationships with provider executives, contracting leaders, and operational partners through transparency, credibility, and consistent follow-through.

Serve as a senior point of escalation for complex provider relationship matters, balancing partnership objectives with The Alliance’s responsibility to employers and members. Monitor provider and contract performance using cost, utilization, access, market, and other available data; identify opportunities for renegotiation, intervention, or strategic development. Assess network gaps, provider opportunities, and market dynamics and recommend strategies that strengthen access, affordability, differentiation, and competitive position.

Partner with providers to resolve systemic issues and improve the effectiveness of the provider relationship and member experience. Leadership & Team Development Lead, coach, and develop provider contracting and relations team members; establish clear expectations, decision rights, priorities, and accountability for results. Build team capability in negotiation, relationship management, reimbursement strategy, market analysis, project execution, and effective cross-functional partnership.

Create scalable workflows, standards, documentation, and operating rhythms that support consistent contracting practices and effective management of the provider portfolio. Allocate team resources and priorities based on organizational strategy, market needs, contract cycles, and emerging provider opportunities or risks. Foster a collaborative, accountable, learning-oriented culture that supports sound judgment, continuous improvement, and strong internal and external relationships.

Cross-Functional Strategy & Organizational Partnership Partner closely with Provider Relations leadership and colleagues across Analytics, Finance, Legal, Operations, Business Development/Employer Engagement, and other functions to develop and execute integrated provider strategies. Translate employer needs, market feedback, financial analysis, and network performance insights into actionable contracting and provider relationship priorities.

Provide provider-market expertise and recommendations in organizational planning, product development, growth initiatives, and strategic decision-making. Communicate complex contracting issues, market dynamics, risks, and recommendations clearly to executive and senior leadership audiences. Ensure key stakeholders are appropriately engaged throughout contracting initiatives and understand decisions, dependencies, implementation requirements, and expected outcomes.

Market Intelligence, Innovation & Growth Maintain a strong understanding of healthcare market trends, provider consolidation, reimbursement practices, regulatory developments, transparency requirements, and emerging payment and delivery models. Analyze external developments and competitive dynamics to anticipate potential impacts on The Alliance’s provider network and employer members. Identify and evaluate opportunities for new provider partnerships, market expansion, alternative contracting approaches, and solutions that improve healthcare value.

Develop data-informed business cases and recommendations for contracting initiatives, provider strategies, and network investments. Operational Excellence, Projects & Vendor Oversight Lead complex provider-facing projects and contracting initiatives from strategy and planning through negotiation, implementation, and transition to ongoing ownership. Establish project objectives, milestones, stakeholder roles, decision points, risks, and communication expectations for major contracting initiatives.

Evaluate and oversee vendors or external partners supporting contracting, network operations, data, or provider-facing work; monitor service, value, and performance. Champion effective use of systems, data, templates, tools, and process improvements that increase contracting discipline, visibility, efficiency, and scalability. Maintain appropriate documentation and support compliance with organizational policies, contractual obligations, and applicable regulatory requirements .

Qualifications Bachelor’s degree in business, healthcare administration, finance, economics, or a related field, or an equivalent combination of education and relevant experience. Minimum of 7 years of progressively responsible experience in healthcare, health insurance, provider network management, or a related field, including at least 3 years of direct provider contracting and/or network management experience.

Demonstrated experience leading complex provider negotiations and developing contracting strategies involving significant financial, operational, or relationship considerations. People leadership experience, including coaching, prioritization, delegation, accountability, and development of professional staff. Strong working knowledge of provider reimbursement methodologies, contract structures and language, network economics, and healthcare regulatory considerations.

Demonstrated ability to interpret financial, utilization, market, and performance data and translate analysis into strategy and action. Experience leading cross-functional initiatives and influencing decisions across functions and levels without relying solely on formal authority. Excellent written, verbal, facilitation, negotiation, and executive-level presentation skills. Proficiency with Microsoft 365 applications and business reporting/analytics tools; ability to learn and effectively use contracting and network-management technologies.

Preferred Qualifications Experience negotiating with large health systems, independent provider groups, surgical centers, ancillary providers, or other complex provider organizations. Experience with self-funded employer health plans, employer coalitions, third-party administrators, or employer-sponsored healthcare strategies. Experience with value-based contracting, bundled payments, centers of excellence, reference-based approaches, or other alternative reimbursement and delivery models.

Experience using healthcare claims, utilization, pricing, or market data to inform contracting strategy and evaluate provider performance. Experience with vendor management, contracting technology, or implementation of tools and processes that improve network operations. Physical Requirements Regularly required to sit and work at a computer for extended periods and participate in virtual and in-person meetings.

Frequently required to communicate verbally and in writing; occasionally required to stand or walk. Visual acuity sufficient to review detailed contracts, data, and computer-based information. Ability to travel regionally as needed for provider meetings, negotiations, organizational meetings, and industry events. Work outside standard business hours may occasionally be required to support negotiations, deadlines, travel, or other business needs.

Remote work flexibility applies in accordance with organizational expectations; in-office workspace options may be available.