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Evry Health seeks a Director of Network Relations to lead the provider network function across all fully insured commercial health plan markets. This is a strategic leadership role with direct accountability for network strategy, regulatory compliance, and complex provider contracting.
Key Responsibilities:
Network Strategy Development & Execution: Develop and continuously refine Evry Health's provider network strategy, including geographic prioritization, contracting targets, payment methodology, and network composition objectives.
Team Leadership & Territory Oversight: Lead, coach, develop, and performance-manage the Network Relations team. Set territory objectives and provide strategic guidance on complex contracting situations.
Complex Contract Negotiation & Value-Based Design: Personally lead high-value, strategically significant provider contract negotiations. Design innovative value-based contracting models that align provider incentives with quality outcomes and cost efficiency.
Network Adequacy Oversight & Regulatory Compliance: Maintain executive-level oversight of network adequacy monitoring and SERFF filing activity. Serve as Evry Health's primary point of accountability to regulators on adequacy matters.
Fee Schedule Governance & Leadership Reporting: Partner with Actuarial on fee schedule benchmarks and rate targets. Deliver regular executive-ready network performance reports to the CMO and leadership team.
Requirements:
Required:
- Bachelor's degree in Business, Healthcare Administration, Economics, or related field
- 10+ years in managed care contracting, provider network development, or provider relations
- 3+ years in a director-level role managing a network contracting team
- Expertise negotiating multi-methodology contracts (including value-based/risk arrangements) and SERFF/adequacy compliance
Preferred:
- MBA, Healthcare Administration, or closely related graduate degree
- Experience building a network function from inception at a growth-stage health plan
- Experience in both health plan-side and provider-side contracting roles
- Knowledge of Texas commercial health insurance market and adequacy requirements
