AVP, Contracting & Network Management

Reporting to Chief of Contracting and Market Management, The AVP of Contracting & Network Management is a senior leadership role responsible for the strategic development, negotiation, and execution of provider network contracts, with a primary emphasis on hospital systems. Accountable for driving high-performing, cost-effective networks, this role leads complex hospital negotiations while overseeing broader provider contracting across IPAs, medical groups, physicians, and ancillary providers. In alignment with corporate standards, the AVP drives innovative contracting strategies, optimizes network design, and advances next-generation care models for Medicare Advantage populations. This leader partners closely with executive leadership to ensure network competitiveness, strong financial performance, and full regulatory compliance., Hospital Contracting Strategy & Execution

• Lead the development and execution of contracting strategies for hospital systems, including acute care hospitals, specialty facilities, and integrated delivery networks (IDNs).
• Negotiate highly complex agreements with hospital executives, including fee-for-service, DRG-based, case rate, bundled payment, and value-based/risk arrangements.
• Drive alignment of hospital contracts with organizational financial targets, medical cost management, and quality outcomes.
• Lead renegotiations and strategic realignment of hospital participation within networks.

Enterprise Provider Contracting Oversight

• In conformance with corporate standards, accountable to lead, manage, negotiate, and implement all types of provider network contracts, including but not limited to IPAs/medical groups, hospitals, direct network physicians, ancillary providers, and supplemental vendors, across both delegated and non-delegated arrangements, serving as a subject matter expert in contract language, structure, and terms.
• Ensure consistency, scalability, and appropriate governance across all provider contracting activities.

Innovation & Value-Based Care

• Develop and execute strategies for innovative approaches to create value through next-generation contracting, network design, and care models for Medicare Advantage, inclusive of diverse compensation arrangements (e.g., capitation, shared savings, global risk, quality incentives and value-based structures).
• Advance value-based arrangements and risk-sharing models that improve outcomes and reduce total cost of care, ensuring alignment of financial incentives, contract structures, and performance expectations.

Network Strategy & Design

• Develop and execute forward-looking strategies for network design, including narrow, tiered, and high-performance networks.
• Leverage the competitive landscape to assess market dynamics and design differentiated network and contracting strategies.
• Ensure networks meet access, CMS adequacy, affordability, and quality standards across all products.

Financial & Analytical Leadership

• Oversee financial modeling and analytics supporting contract negotiations, including rate development, impact modeling, and ROI analysis.
• Monitor key performance indicators such as unit cost trends, utilization, and provider performance.
• Identify opportunities for cost containment, efficiency, and value optimization across the network.

Leadership & Operational Excellence

• Establish department key performance indications, define success measures, and set clear performance expectations for staff and market leadership.
• Lead, mentor, and develop a high-performing contracting and network management team.
• Drive accountability, transparency, and continuous improvement within the function.

Cross-Functional Collaboration

• Partner with Finance, Market leadership, Clinical, Legal, Compliance, Product and other key functional areas to align contracting strategies with enterprise goals.
• Serve as a strategic advisor to executive leadership on hospital market dynamics and network performance.

Compliance & Risk Management

• Ensure all contracting activities comply with federal and state regulations, including CMS requirements.
• Partner with Legal to mitigate contractual risk and maintain strong governance and standardized contract language

Supervisory Responsibilities:

Oversees assigned staff that support the network management needs of the markets. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Do you have experience in Terms and conditions negotiation?, Do you have a Bachelor's degree?, To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Minimum Experience: 10+ years of experience in healthcare contracting and network management, with deep expertise in hospital contracting.

• Education/Licensure: Requires a BA/BS; MBA strongly preferred.

• Other: Deep expertise in Medicare Advantage contracting, including reimbursement methodologies, contract structuring and language, negotiation strategy, financial modeling, and managed care. Proven success negotiating complex agreements with large hospital systems and IDNs. Strong understanding of value-based care and risk-based reimbursement arrangements. Demonstrated leadership experience with the ability to build, lead, and scale high-performing teams. Advanced analytical, financial modeling, and strategic thinking capabilities. Exceptional communication skills and executive presence. Proven ability to develop and execute network strategies that drive performance. Strong collaboration skills, with the ability to influence, gain buy-in, and incorporate diverse perspectives. Proficiency in Microsoft Office (Word, Excel, PowerPoint). Experience with delegated and non-delegated provider models. Demonstrated ability to manage and optimize medical cost through network strategies. Travel up to 25%, as needed. Strong organizational and project management skills.

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. Reporting to Chief of Contracting and Market Management, The AVP of Contracting & Network Management is a senior leadership role responsible for the strategic development, negotiation, and execution of provider network contracts, with a primary emphasis on hospital systems. Accountable for driving high-performing, cost-effective networks, this role leads complex hospital negotiations while overseeing broader provider contracting across IPAs, medical groups, physicians, and ancillary providers. In alignment with corporate standards, the AVP drives innovative contracting strategies, optimizes network design, and advances next-generation care models for Medicare Advantage populations. This leader partners closely with executive leadership to ensure network competitiveness, strong financial performance, and full regulatory compliance.