Provider Network Manager Jobs in Utah (NOW HIRING)

The Senior Provider Network Contractor is a highly specialized negotiator responsible for strategically engaging out-of-network healthcare providers and facilities to secure in-network participation at competitive, market-aligned rates for a health plan. This role is focused on high-impact, complex negotiations intended to reduce out-of-network spend, improve network adequacy, and support affordability and access objectives. The contractor operates with a high degree of autonomy and serves as a subject-matter expert in provider reimbursement, market dynamics, and managed care contracting strategies.

Identify and prioritize high-cost, high-utilization, and strategically critical out-of-network providers and facilities based on claims data, network gaps, and regulatory network adequacy requirements. Develop and execute targeted outreach strategies to engage providers with significant leverage or market influence. Serve as the primary point of contact provider practice leadership Articulate the health plan’s value proposition, network strategy, and long-term partnership opportunities to prospective in-network providers.

Lead complex, high-stakes negotiations with out-of-network providers to achieve competitive reimbursement rates and favorable contract terms. Apply advanced knowledge of reimbursement methodologies, including professional fee schedules, DRGs, APCs, per diems, case rates, and alternative payment models, as appropriate. Leverage market intelligence, benchmarking data, and utilization analytics to support evidence-based negotiation strategies. Structure agreements that balance provider market realities with the health plan’s financial targets, affordability goals, and regulatory constraints. Negotiate contract provisions beyond rates, including escalation terms, termination clauses, value-based incentives, and operational requirements.

Partner closely with internal health plan teams, including Finance, Legal, Utilization Management and Operations to ensure alignment with enterprise objectives. Provide expert guidance and recommendations to health plan leadership on negotiation strategy, market trends, and provider leverage dynamics. Ensure smooth transition of executed agreements into contract management, credentialing, and claims systems. Proactively identify and resolve barriers to provider participation and onboarding.

Track and report measurable outcomes, including conversion of out-of-network providers to in-network status, negotiated rate improvements, and reductions in out-of-network spend. Provide executive-level reporting on negotiation progress, financial impact, and network adequacy improvements. Maintain thorough documentation of negotiation strategies, outcomes, and contractual terms.

• Bachelor's degree required 8 years of progressive experience in managed care contracting and network negotiations within a health plan or comparable payer environment.
• Proven track record of leading complex, high-value provider negotiations and securing favorable in-network agreements.
• Deep expertise in healthcare reimbursement models, provider economics, and managed care regulatory frameworks.
• Strong understanding of provider market consolidation, competitive dynamics, and leverage strategies.
• Exceptional negotiation, influence, and executive-level communication skills.
• Ability to operate independently with minimal oversight in a contractor or consulting capacity.

• Advanced degree (MBA, MHA, JD) strongly preferred.
• Experience negotiating with large health systems, academic medical centers, and highly specialized provider groups.
• Demonstrated success reducing out-of-network spend through targeted contracting initiatives.
• Familiarity with state and federal network adequacy requirements applicable to health plans (e.g., Medicaid, Medicare Advantage, Commercial).
• Experience supporting or advising executive leadership on managed care strategy.

HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $122,900 - $188,020 All Other Locations (within approved locations): $105,100 - $160,480

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

Healthfirst is New York's largest not-for-profit health insurer offering its nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst's unique advantage is rooted in its belief that good health doesn't start in a doctor's office. The company's mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well‑being. This value-based care model is the foundation of the company's sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people's lives, then Healthfirst is for you.

Thank you for considering a career with HF Management Services, LLC.