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.