Soma Capital Portfolio Jobs

Senior Director Network Development



Sales & Business Development
Posted on Friday, August 18, 2023

Remote with occasional travel (5-10%) 7 years of experience Negotiate competitive managed care agreements with complex providers, including hospital systems, PHOs, and large IPAs. Existing relationships with hospitals in Texas and/or Florida will be helpful

Duties And Responsibilities

  • Manages increasingly complex contract negotiations with hospitals and other providers for Commercial product lines (e.g., Hospital systems, Ancillaries, and large physician groups).
  • Proactively builds relationships that nurture provider partnerships to support the local market strategy.
  • Initiates, nurtures and maintains effective channels of communication with matrix partners including but not limited to, Claims, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing.
  • Supports and provides direction to develop network analytics required for the network solution.
  • Responsible for meeting unit cost targets, while preserving an adequate network, to achieve and maintain competitive position.
  • Identify and manages initiatives that improve total medical cost and quality.
  • Prepares, analyzes, reviews, and projects financial impact of high spend or increasingly complex provider contracts and alternate contract terms.
  • Assists in resolving elevated and complex provider service complaints. Research problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
  • Manages key provider relationships and is accountable for critical interface with providers and business staff.
  • Demonstrates comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape.
  • Partner with Regulatory Affairs to ensure all network filings are timely and accurate

Position Requirements

  • 4 year/Bachelor’s degree.
  • 7+ years Contracting and Negotiating experience involving complex delivery systems and organizations required
  • Experience with Physician, Hospital and Ancillary group contracting and negotiations
  • Experience negotiating delegated and capitated agreements
  • Experience in developing and managing key provider relationships including senior executives
  • Knowledge of complex reimbursement methodologies
  • Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners
  • Intimate understanding and experience with larger, more complex integrated delivery systems managed care, and provider business models
  • Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
  • The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations
  • Customer centric and interpersonal skills are required
  • Superior problem solving, decision-making, negotiating skills, contract language and financial acumen