Leads specialist capitation provider contracting strategies, negotiations, relationships, reimbursement modeling, contract administration, and compliance. Oversees DOFRs, amendments, RFPs, contracting initiatives, risk assessment, and issue resolution while partnering with Claims, Configuration, Business Development, and Data Management. Provides executive guidance, reports, and recommendations regarding network adequacy, financial impact, regulatory requirements, and strategic opportunities. Establishes enterprise contracting processes and serves as the escalation point for critical provider and payer issues.
Job Title: Director – Provider Contracting
Department: Contracting
Department: Contracting
About the Role:
We are currently seeking a highly motivated Director – Provider Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Alhambra, CA and Monterey Park, CA and at home on a weekly basis.
This role will work closely with the VP of Contracting to develop and execute on managed care capitated specialist contracting strategies and negotiations. You will be responsible for identifying and evaluating specialist capitation provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.
What You'll Do
- Own and manage capitated specialist relationships with senior leadership, serving as the escalation point for critical issues and long-term partnership development.
- Design and oversee contracting strategies aligned with organizational goals for growth, compliance, and cost-effectiveness.
- Act as a thought leader, providing executive-level guidance on contracting initiatives.
- Direct and ensure proper administration of Division of Financial Responsibility (DOFRs), contract amendments, and RFPs.
- Oversee project management of all specialist capitation contracting initiatives, ensuring timely, compliant execution.
- Interpret and assess contractual risk in provider agreements, leading high-stakes, time-sensitive negotiations.
- Ensure contracts optimize reimbursement, protect the organizations' interests, and strengthen provider relationships.
- Establish and maintain policies and processes that streamline contract review, approval, and execution across the enterprise.
- Partner with Claims, Configuration, Business Development, and Data Management to align operations with contracting strategies.
- Drive root-cause solutions to systemic issues affecting contract performance or compliance.
- Provide executive-level reports and recommendations to senior leadership on network adequacy, financial impact, and strategic opportunities related to specialist capitation agreements.
- Other duties as assigned.
Qualifications
- Master’s degree and/or Bachelor’s degree (BS/BA) in business administration or a health care related field, or equivalent experience
- Have at least 10 years of prior experience in capitation contracting with Specialists.
You're great for this role if:
- You can analyse complex financial data, contracts, and regulatory documents with accuracy and insight.
- You bring strong problem-solving skills and a strategic, methodical approach to delivering sustainable solutions.
- You are highly organised, detail-focused, and effective at leading teams through thorough investigations with ambiguous or incomplete information.
- You communicate clearly, verbally and in writing, and can translate technical and contractual language into practical recommendations for executives and stakeholders.
- You have deep knowledge of delegated network operations and regulatory requirements, including overseeing compliance in complex healthcare settings.
- You are highly proficient in Microsoft Excel, Word, and PowerPoint, using them for strategic presentations, contract modelling, and executive reporting.
- You understand EZ-Cap and other proprietary healthcare administration systems and can lead teams that use these platforms effectively.
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754 and 600 City Parkway West, Orange, CA 92868.
- The annual total compensation target pay range for this role is: $124,000 - $145,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
About
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Astrana Health, Inc. Alhambra, California, USA Office
Alhambra, CA, United States
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