The Squires Group, Inc. · 2 weeks ago
Director Network Contracting and Provider Strategy
Washington, DC
Full-time
Hybrid
Director/Executive
$180K/yr - $180K/yr
8+ years expThe Squires Group, Inc. is seeking an experienced Director of Network Contracting and Provider Strategy to oversee value-based care strategies, provider contracting, and network development for a leading health plan in the District of Columbia. This key leadership role involves supervising a team, negotiating provider reimbursement arrangements, and ensuring the growth of a high-quality provider network.
Information Technology
No H1B
U.S. Citizen OnlyHiring Manager
Ed Kennedy
Responsibilities
Lead network development, provider recruitment, contracting, and retention initiatives to ensure access to quality, cost-efficient care
Negotiate provider reimbursement rates, contract terms, and alternative payment methodologies (e.g., shared savings, risk sharing, bundled arrangements)
Direct the Provider Relations team, including daily operations, hiring, performance evaluations, mentoring, and professional development
Develop and oversee value-based care arrangements and provider pay-for-performance programs
Collaborate with finance, operations, and legal teams to manage all financial, operational, and compliance aspects of provider contracts
Ensure compliance with all state and federal regulatory requirements, including Medicaid and Medicare standards
Oversee the development and implementation of provider education programs and initiatives to strengthen provider engagement
Monitor cost containment initiatives and implement strategies to meet strategic goals
Provide leadership and guidance on complex reimbursement and contracting issues, including APR-DRG hospital reimbursement methodology and claims adjudication
Assess market readiness for network expansion and development in targeted states
Qualification
Required
Green Card Holder or U.S. Citizenship
Bachelor's degree in a related field required
8–10 years of experience in managed care/healthcare, with strong provider contracting and network development expertise
5–7 years of experience with government programs, specifically Medicaid and Medicare
Hands-on experience with provider pay-for-performance programs and value-based care reimbursement models
Significant experience managing provider networks (primary care and specialty) with focus on access to care
5–7 years of supervisory experience, including direct staff leadership and team development
Strong knowledge of APR-DRG hospital reimbursement methodology and claims adjudication systems
Exceptional negotiation, problem-solving, and decision-making skills
Strong financial acumen with proven contracting and data analysis experience
Ability to manage multiple projects and priorities effectively
Excellent written and verbal communication skills, including formal presentations
Proficiency with MS Office (Word, Excel, PowerPoint) and database applications
Demonstrated ability to build collaborative provider relationships to support quality and financial initiatives
Knowledge of state and federal regulatory requirements, with broad experience in both commercial and government healthcare contracting
Preferred
Master's degree in Business or Healthcare Administration preferred
Benefits
Relocation support may be available depending on compensation needs.
Company
The Squires Group, Inc.
The Squires Group provides short-term, long-term, and permanent ERP, IT, Cyber, and Accounting/Finance experts to private and public sector clients.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase