Job Summary:The Director, Network Performance and Strategy is responsible for providing strategic leadership for the enterprise Network Performance and Strategy function across markets and lines of business. They will lead the development and execution of network performance management, network optimization, and network strategy capabilities designed to improve affordability, access, quality, provider performance, network competitiveness, and overall plan performance. This role serves as a strategic advisor to leadership, translating network performance intelligence into actionable strategies and scalable solutions while respecting market accountability and decision rights.
Essential Functions:- Develops standardized frameworks for evaluating network performance, including provider performance, network adequacy and access, utilization, affordability, leakage/OON utilization, quality, contracting performance, and other relevant network measures.
- Translates network performance intelligence into strategies that improve market performance, affordability, quality, network adequacy, growth, and competitive positioning.
- Serves as a strategic advisor to network leadership, providing enterprise benchmarks, insights, and scalable solutions.
- Establishes enterprise standards and methodologies that enable consistent network performance management while allowing appropriate market-level flexibility.
- Leads the development of enterprise network performance reporting, analytics, decision-support tools, and enabling technologies, including automation, AI, and proprietary platforms.
- Partners with Medical Economics and Actuarial leadership to ensure network performance methodologies and analytical models are appropriately developed, governed, and applied.
- Partners with Value-Based Contracting leadership to provide network performance intelligence, provider segmentation, performance insights, and strategic recommendations that support VBC strategy.
- Partners with Network Contracting to translate network intelligence into contracting priorities, provider targeting, reimbursement strategies, and network optimization opportunities.
- Identifies and prioritizes enterprise network opportunities and develops supporting business cases.
- Oversees deployment of network performance capabilities across markets, driving adoption, change management, and measurable business impact.
- Evaluates emerging technologies, data sources, vendors, and industry practices to strengthen network performance capabilities.
- Develops and manages the team's operating plan, talent strategy, priorities, and resource allocation.
- Represents Network Performance & Strategy with executive leadership and cross-functional stakeholders.
- Establishes accountability for measurable outcomes and evaluates team impact on network performance and business objectives.
- Perform any other job related duties as requested.
Education and Experience:- Bachelor's degree in healthcare administration, business, analytics, economics, public health, or related field required
- Master's degree, MBA, MHA, MPH, or advanced quantitative degree preferred
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Ten (10) years of progressive experience in managed care, healthcare strategy, network management, provider performance, medical economics, healthcare analytics, or related areas required
- Five (5) years of experience in leadership roles required
- Experience in Medicaid managed care and/or Medicare Advantage preferred
- Experience with network optimization, provider performance, value-based care, reimbursement, or medical cost management preferred
Competencies, Knowledge and Skills:- Demonstrated understanding of health-plan network strategy, provider performance, healthcare economics, and managed-care operations
- Skilled in using advanced analytics, AI, or technology-enabled operating models to increase organizational leverage
- Skilled in leading enterprise capabilities across a geographically dispersed health-plan organization
- Familiarity with operating across multiple markets, business units, or lines of business
- Strong executive communication, relationship management, and strategic problem-solving skills
- Skilled in enterprise network strategy
- Skilled in network performance management
- Strategic problem solving
- Familiarity with healthcare economics
- Executive leadership skills
- Cross-functional influence skills
- Skilled in developing and analyzing Market strategy
- Knowledgeable in Provider performance
- Change management skills
- Data-driven decision making skills
- Organizational leadership skills
Licensure and Certification:Working Conditions:- General office environment; may be required to sit or stand for extended periods of time
- Up to 25% (regular) travel to attend meetings, trainings, and conferences may be required
Compensation Range:
$113,000.00 - $197,700.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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