Partnership Lead

New

Skills

Performance management

Own the strategy, contracting, implementation, and performance management of provider network and care pathway partnerships. Identify and evaluate new provider network opportunities. Develop differentiated network configurations to support broker distribution. Ensure network economics align with underwriting and pricing strategy. Support geographic expansion with scalable network infrastructure. Build partnerships with centers of excellence, specialty providers, and clinical programs. Structure bundled pricing or value-based agreements. Integrate care pathways into clinical and claims workflows. Ensure pathways are operationally executable, measurable, and scalable. Lead negotiations with provider groups, networks, and specialty partners. Establish performance-based terms, SLAs, data-sharing requirements, and governance. Align contracts with stop-loss, reimbursement, and regulatory requirements. Coordinate with Legal and Finance through contract execution. Partner with TPA leadership for integration into systems. Establish implementation timelines, go-live criteria, and escalation paths. Monitor performance post-launch and drive operational optimization. Define and track KPIs for cost, access, utilization, and member experience. Conduct partner performance reviews and identify improvement opportunities. Resolve operational friction points impacting claims accuracy and member experience. Refine network and pathway strategy based on performance data. 7–10+ years of experience in provider networks, care delivery partnerships, or TPA/health plan operations. Direct experience in negotiating and contracting provider or network agreements. Strong understanding of claims administration, stop-loss structures, and reimbursement models. Working within or alongside a TPA, carrier, MGU, or self-funded plan environment. Proven ability to lead cross-functional initiatives from strategy through execution. With specialty pharmacy or high-cost episode management (nice to have). Exposure to value-based contracting models (nice to have). With broker-distributed health plans (nice to have). Familiarity with level-funded or self-funded plan design (nice to have).

Key Responsibilities
  • Own the strategy, contracting, implementation, and performance management of provider network and care pathway partnerships.
  • Identify and evaluate new provider network opportunities.
  • Develop differentiated network configurations to support broker distribution.
  • Ensure network economics align with underwriting and pricing strategy.
  • Support geographic expansion with scalable network infrastructure.
Required Skills & Qualifications
  • 7–10+ years of experience in provider networks, care delivery partnerships, or TPA/health plan operations.
  • Direct experience in negotiating and contracting provider or network agreements.
  • Strong understanding of claims administration, stop-loss structures, and reimbursement models.

Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: 12 Months

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