Lead managed care contracting strategy and negotiations, draft and manage payer/provider contracts (risk-based, FFS, ACOs), evaluate reimbursement and financial performance, develop contract analytics/tools, ensure enterprise contracting consistency, resolve payer/provider issues, and manage ad-hoc projects.
Job Title: Senior Director – Payer Contracting
Department: Contracting
About the Role:
We are currently seeking a highly motivated Senior Director – Payer Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Orange, CA and Monterey Park, CA and at home on a weekly basis. This role will work closely with the SVP of Payer Contracting to develop and execute on managed care contracting strategies and negotiations. You will be responsible for identifying and evaluating payor and provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation and fee for service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.
Department: Contracting
About the Role:
We are currently seeking a highly motivated Senior Director – Payer Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Orange, CA and Monterey Park, CA and at home on a weekly basis. This role will work closely with the SVP of Payer Contracting to develop and execute on managed care contracting strategies and negotiations. You will be responsible for identifying and evaluating payor and provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation and fee for service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.
What You'll Do
- Leads contract negotiations, as assigned, including risk-based agreements, fee-for-service negotiations, pay for performance programs, and ACO agreements with health plans
- Manages contractual relationships with payers and internal stakeholders
- Reviews health plan contract language and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
- Circulates draft contract terms/language to various internal departments for review & approval
- Applies knowledge of healthcare delivery system, IPA operations, managed care, healthcare laws in assisting with the development of contracting strategies
- Answers and/or resolves inquiries from health plans or internal departments in a timely manner
- Establishes good working relationships with health plan representatives and internal teams
- Develops tools (e.g., dashboards, grids, tables, summaries) to provide organizational leadership key contract data
- Utilizes applicable financial tools and reports to evaluate performance of current contracts
- Interacts and consults with Network Pricing team to evaluate different financial arrangements and recommend applicable payment methodologies
- Ensures compliance and consistent contracting across the enterprise.
- Manages various ad-hoc project requests with short turnaround time.
- Performs other duties as assigned.
Qualifications
- Master’s degree and/or Bachelor’s degree or BS/BA in business administration or health care related field of study or equivalent years of experience
- Direct experience leading health plan/provider negotiations
- Experience with financial models analyzing health plan agreements
- At least 10 years prior experience in contracting
You're great for this role if:
- Experience in risk-based contracting and associated financial analysis strongly preferred
- Ability to close deals under tight deadlines-sense of urgency
- Comfortable in negotiating all types contracts from start to finish within defined parameters
- Experience with FFS, capitation, and risk sharing arrangements
- Experience with government programs (Medicare, Medi-Cal, D-SNP)
- Experience working with health plan, provider and hospital counterparts
- Knowledge of California payer, Institutional and IPA contracting
- Successful experience negotiating contracts for all Lines of Business (Commercial, Medicare, Medicaid, and Accountable Care)
- Project management skills/experience
- Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
- Proficient in MS Excel (including use of functions and pivot tables) and PowerPoint software
- Demonstrated ability to work with effectively with multiple different areas within an organization (both internal and external)
- Proven ability to work effectively both independently and with teams in a dynamic and fast paced environment
- Proven leadership/strategy and organizational skills are required, as well as excellent written and verbal communication skills
- Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies
- Experience with healthcare operations, systems, and financial/claims data analysis
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: $175,000 - $185,000. 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
Similar Jobs
%20(1).png)
Consumer Web • Digital Media • Enterprise Web • Marketing Tech • News + Entertainment • Software • Generative AI
Own the full enterprise sales cycle for Hedra's API and inference platform, selling to developers, ML and platform teams. Prospect, close, and expand Fortune 100 and enterprise accounts, collaborate with product/engineering, and drive adoption by addressing latency, cost, model quality, and integration needs.
Top Skills:
APIsGenerative AiInferenceMachine LearningReal-Time Video GenerationVisual Intelligence
Consumer Web • Digital Media • Enterprise Web • Marketing Tech • News + Entertainment • Software • Generative AI
Own post-sales technical relationships for Hedra's API, agent, and inference customers: onboard, debug integrations, architect production deployments for latency/cost/reliability, drive adoption and expansion with AEs, translate customer issues into product improvements, and build runbooks and reference integrations.
Top Skills:
APIsPythonSdks
Big Data • Cloud • Software • Database
Provide escalated technical support for large, mission-critical MongoDB deployments: troubleshoot Linux, database, networking, cloud, and Kubernetes issues; analyze workloads and logs; recommend sizing and optimizations; communicate empathetically with customers; contribute knowledge articles and mentor teammates.
Top Skills:
Active DirectoryAtlasAWSAzureCC++Cloud ManagerCompassDnsFirewallsGCPGoGrafanaHttp/SJavaKerberosKubernetesLoad BalancersMongoDBMongodb Kubernetes OperatorOidcOps ManagerPrometheusProxiesPythonRubyTcp/IpTlsVector SearchVpns
What you need to know about the Los Angeles Tech Scene
Los Angeles is a global leader in entertainment, so it’s no surprise that many of the biggest players in streaming, digital media and game development call the city home. But the city boasts plenty of non-entertainment innovation as well, with tech companies spanning verticals like AI, fintech, e-commerce and biotech. With major universities like Caltech, UCLA, USC and the nearby UC Irvine, the city has a steady supply of top-flight tech and engineering talent — not counting the graduates flocking to Los Angeles from across the world to enjoy its beaches, culture and year-round temperate climate.
Key Facts About Los Angeles Tech
- Number of Tech Workers: 375,800; 5.5% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Snap, Netflix, SpaceX, Disney, Google
- Key Industries: Artificial intelligence, adtech, media, software, game development
- Funding Landscape: $11.6 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Strong Ventures, Fifth Wall, Upfront Ventures, Mucker Capital, Kittyhawk Ventures
- Research Centers and Universities: California Institute of Technology, UCLA, University of Southern California, UC Irvine, Pepperdine, California Institute for Immunology and Immunotherapy, Center for Quantum Science and Engineering
