Network Optimization Director Jobs (NOW HIRING)

Job Description Summary

The Network Contracting Director is responsible for leading the strategy, development, negotiation, and management of CareMore Health's professional and ancillary provider networks, ensuring high-quality, coordinated, and cost-effective care. This leadership role oversees a team of contracting professionals responsible for negotiating, implementing, and administering provider agreements serving Medicare Advantage, Medicaid, and other managed care populations.
Reporting to senior Network Management leadership, the Director is a strategic, analytical, and collaborative leader who thrives in a fast-paced, evolving environment. They possess exceptional negotiation and relationship management skills, are comfortable using data to drive decisions, and can translate organizational objectives into actionable contracting strategies that optimize patient access, affordability, quality outcomes, and financial performance. This individual must be able to effectively lead multiple priorities simultaneously while fostering strong internal and external partnerships. The Director partners closely with executive leadership, Finance, Clinical Operations, Provider Data Management, Legal, Local Leadership, Utilization Management, and Strategic Initiatives to advance CareMore's value-based care model.

How will you make an impact & Requirements

Key Responsibilities:

Strategic Leadership

• Develop and execute the provider contracting strategy in alignment with CareMore Health's enterprise objectives, value-based care initiatives, affordability targets, and market growth priorities.

• Translate long-term network strategies into annual contracting plans, measurable business objectives, and operational priorities across multiple provider segments and geographic markets.

• Lead contracting strategies that improve provider access, network adequacy, affordability, quality performance, and member experience.

• Evaluate healthcare market trends, competitive intelligence, reimbursement innovation, and regulatory changes to proactively position CareMore's provider network for future growth and sustainability.

Contracting & Network Management

• Provide executive oversight of provider contracting activities across physician and ancillary networks.

• Guide negotiations for high-value, strategically significant provider agreements, serving as executive sponsor for complex negotiations involving health systems, physician organizations, and integrated delivery networks.

• Oversee provider reimbursement strategies, alternative payment models, and value-based contracting initiatives that support population health and financial sustainability.

• Ensure timely execution, implementation, and ongoing administration of provider agreements while maintaining compliance with organizational policies and regulatory requirements.

• Monitor provider performance and partner with internal stakeholders to address network gaps and contracting opportunities.

Analytics & Strategic Planning

• Leverage analytics, financial modeling, utilization data, and market intelligence to evaluate provider performance and identify contracting opportunities.

• Monitor network performance, utilization trends, provider access, and key performance indicators to drive continuous improvement.

• Complete financial and performance modeling for non-complex contract changes to develop rate proposals, form negotiation strategy, and measure impact to the business.

Leadership & Talent Development

• Lead, coach, and develop a high-performing contracting organization comprised of managers, senior analysts, and contracting professionals.

• Establish clear performance expectations, succession plans, and professional development opportunities that build organizational capability and leadership bench strength.

• Foster a culture of accountability, collaboration, innovation, continuous improvement, and customer service across the contracting organization.

• Ensure effective workload planning, resource allocation, prioritization, and organizational alignment to meet evolving business priorities.

Financial & Business Partnership

• Partner with Finance, Local Markets, Clinical Operations, Utilization Management, and Strategy leaders to evaluate the financial and operational impacts of provider contracting decisions.

• Oversee development of executive reporting, provider performance analyses, reimbursement modeling, and contracting analytics that support enterprise decision-making.

• Provide strategic recommendations regarding provider investments, reimbursement methodologies, network optimization, and healthcare affordability initiatives.

• Monitor provider cost trends, utilization patterns, quality performance, and network economics to identify opportunities for improvement and risk mitigation.

Governance & Operational Excellence

• Establish and maintain enterprise contracting governance, documentation standards, contract lifecycle management processes, and operational controls.

• Partner with Legal, Compliance, Credentialing, Configuration, Provider Operations, and Claims leadership to ensure seamless implementation and administration of provider agreements.

• Ensure compliance with delegated Health Plan requirements, provider network adequacy standards, accreditation requirements, and organizational policies.

• Lead continuous improvement initiatives that enhance contracting workflows, operational efficiency, reporting capabilities, provider experience, and data integrity.

• Adapt quickly to changing business priorities and operate effectively in ambiguous environments.

• Represent CareMore Health in executive provider meetings, industry forums, and strategic partnership discussions as appropriate.

Qualifications:

Minimum Qualifications

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, Economics, Public Health, or a related field, or equivalent combination of education and experience.

• Must reside in Arizona, California, or Nevada.

• 7-10+ years of progressively responsible experience in provider network contracting, managed care, healthcare finance, or provider reimbursement.

• Demonstrated leadership experience managing contracting organizations, including managers and professional staff.

• Strong analytical skills with the ability to interpret financial models, utilization data, provider performance metrics, and market intelligence to drive strategic decisions.

• Exceptional negotiation, communication, and relationship-building skills with the ability to influence stakeholders at all organizational levels.

• Ability to effectively manage multiple strategic initiatives in a fast-paced, evolving environment.

• Comfortable navigating ambiguity and adapting quickly to changing organizational priorities and market conditions.

• Deep expertise in provider reimbursement methodologies, value-based payment models, managed care contracting, and network economics.

• Demonstrated success developing and executing provider contracting strategies that improve financial performance, provider engagement, and member access.

• Strong executive communication, financial analysis, negotiation, and organizational leadership skills.

Preferred Qualifications

• Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH), Finance, or a related field.

• Extensive experience supporting Medicare Advantage, Medicaid managed care, dual-eligible populations, and integrated care delivery models.

• Experience designing and implementing value-based reimbursement arrangements, risk-sharing agreements, capitation models, and provider incentive programs.

• Knowledge of CMS regulations, provider network adequacy requirements, healthcare compliance, and accreditation standards.

• Familiarity working with providers across Arizona, California, and Nevada.

• Experience collaborating with executive leadership on enterprise strategy, market expansion, and healthcare transformation initiatives.

Leadership Competencies

• Strategic Leadership

• Organizational Leadership

• Provider Network Strategy and Optimization

• Value-Based Care Leadership

• Executive Influence

• Financial and Business Acumen

• Relationship Management

• Talent Development and Coaching

• Change Leadership

• Healthcare Market Strategy

• Cross-Functional Collaboration

• Accountability and Results Oriented

• Executive Decision Making

• Innovation

• Operational Excellence

• Regulatory and Compliance Leadership

Travel Requirements

Travel is required as needed to support clinical teams and operations across multiple markets including California, Nevada and Arizona. Travel will only amount to between 15-20% of your work time.

Benefits:

• Membership in our Flexible Paid Time Off program

• Medical, Dental, Vision

• Employer Paid Basic Life & Short Term Disability coverage (goes into effect after 1 year of full-time employment)

• 401(k) with match

• Employee Wellness

• Other Employee Discount programs like Tickets at Work and cell phone discounts

• Other benefits: Dependent Care FSA, Voluntary Life, Long Term Disability, Critical Illness, Pet Insurance, and more

About Mosaic Health

Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health, including apree health, Millennium Physician Group, and CareMore Health, are multi-payer and serve nearly one million individuals across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations. For more information, visit www.mosaichealth.com.

Compensation Range:

$131,243.00

to

$236,238.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.