Director of Contracting
Job Overview
The Dir of Contracting & Network Management is a leadership role responsible for developing, negotiating, and managing provider contracts and networks for the health plan. This leader ensures that provider networks are adequate, efficient, financially sustainable, and aligned with the organization’s strategic goals (e.g., value-based care, member access, cost containment). The role combines strategy, operations, regulatory compliance, provider relationships, analytics, and financial oversight.
Responsibilities
Key Responsibilities
Network Strategy & Design · Develop, lead and execute provider network strategies to ensure sufficient access across specialties and geographies. · Evaluate market trends, competitor networks, member needs, and regulatory requirements. · Identify network adequacy gaps (geographic, specialty, quality) and develop plans to close them. Contracting & Negotiations · Negotiate contracts with hospitals, physician groups, ancillary providers, and facility partners. · Manage contract lifecycle: drafting, reviewing, executing, renewing, amending, termination. · Structure payment/reimbursement models, including fee‐for‐service, capitation, bundled payments, shared savings, etc. · Ensure terms in contracts align with financial targets, risk tolerances, quality goals, and regulatory obligations. Provider Relations & Network Management · Maintain and strengthen relationships with providers; serve as point of escalation for issues. · Oversee provider data integrity, delegation oversight, and provider performance. · Facilitate provider satisfaction, addressing service or payment concerns. · Support provider onboarding, education around contract terms, and performance expectations. Operational Oversight & Compliance · Lead operational functions such as network administration, provider directory maintenance, delegation oversight. · Ensure network adequacy meets federal/state regulatory requirements. · Oversee policies, procedures, and systems to track and govern contracting and network operations. · Coordinate with legal, finance, compliance, claims, member services, and other stakeholders. Value-Based Care & Cost Management · Lead or support the development of value‐based contracting models · Work with analytics team to develop monitoring for utilization, cost trends, provider performance, and identify improvement opportunities. · Develop reimbursement strategies that balance cost, access, quality, and provider incentives. Financial Management & Analytics · Develop and manage budgets for network and contracting functions. · Forecast network costs, provider reimbursements; assess financial impacts of different contracting strategies. · Monitor medical loss ratio (MLR) and other cost drivers associated with provider contracts. Leadership & Team Management · Build, lead, mentor, and manage a high performing team spanning contracting, provider relations, network operations, and other cross functional teams for implementation. · Set goals, provide feedback, drive accountability. · Foster a culture of collaboration, continuous improvement, and responsiveness. Stakeholder Engagement & Internal Collaboration · Serve on senior leadership teams; align network & contracting strategy with organizational objectives. · Collaborate with product development, sales, marketing to ensure network adequacy supports product offerings. · Coordinate with utilization management, quality, member services, clinical, legal, and regulatory affairs. Regulatory & Industry Monitoring · Stay current on relevant state and federal regulations (e.g., network adequacy, reimbursement law) · Monitor trends in managed care, payer/provider innovations, competitive market shifts. · Adapt strategies to evolving regulatory requirements and market conditions. |
Qualifications
Bachelor’s degree preferred or related years of contracting and leadership experience
Experience:
- At least 5 years of experience in managed care, health plan operations, provider contracting, or network management.
- Proven progress from operational to strategic leadership roles.
- Prior experience negotiating complex provider contracts (hospital systems, physician groups, ancillary providers).
- Experience with value-based contracting, risk sharing, capitation, bundled payments, shared savings, etc.
- Demonstrated ability to manage and develop teams.
Skills & Knowledge:
- Strong financial acumen; ability to model cost/reimbursement scenarios.
- Excellent negotiation, communication, and relationship building skills.
- Ability to use data/analytics to drive decision making.
- Knowledge of regulatory requirements (state/federal), accreditation standards, network adequacy requirements.
- Change management, strategy implementation, cross-functional leadership.
About Us
Notice of Use of Artificial Intelligence Tools in the Recruitment Process
At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing by leading with integrity, accountability, and transparency in all that we do.
As part of our hiring process, we may use third-party artificial intelligence (AI) tools to assist in processing employment-related information. These tools are used to support our recruitment activities and are subject to human oversight and review. BrightSpring does not use AI to make employment decisions independently, and AI is not used to discriminate against applicants or employees. We do not use zip codes as a proxy for protected characteristics. All hiring decisions are made by people, including our recruiters and hiring leaders.
BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities. If you need a reasonable accommodation during the application or hiring process, please contact your recruiter or email TalentAcquisition@brightspringhealth.com. For additional information about how our company uses AI in the hiring process, please contact TalentAcquisition@brightspringhealth.com.
BrightSpring is an Equal Opportunity Employer.
BrightSpring Health Services and its affiliated companies provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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