Job Summary:
The Director, Network Performance and Strategy is responsible for providing strategic leadership for the enterprise Network Performance and Strategy function across markets and lines of business. They will lead the development and execution of network performance management, network optimization, and network strategy capabilities designed to improve affordability, access, quality, provider performance, network competitiveness, and overall plan performance. This role serves as a strategic advisor to leadership, translating network performance intelligence into actionable strategies and scalable solutions while respecting market accountability and decision rights.
Essential Functions: Develops standardized frameworks for evaluating network performance, including provider performance, network adequacy and access, utilization, affordability, leakage/OON utilization, quality, contracting performance, and other relevant network measures.
Translates network performance intelligence into strategies that improve market performance, affordability, quality, network adequacy, growth, and competitive positioning.
Serves as a strategic advisor to network leadership, providing enterprise benchmarks, insights, and scalable solutions.
Establishes enterprise standards and methodologies that enable consistent network performance management while allowing appropriate market-level flexibility.
Leads the development of enterprise network performance reporting, analytics, decision-support tools, and enabling technologies, including automation, AI, and proprietary platforms.
Partners with Medical Economics and Actuarial leadership to ensure network performance methodologies and analytical models are appropriately developed, governed, and applied.
Partners with Value-Based Contracting leadership to provide network performance intelligence, provider segmentation, performance insights, and strategic recommendations that support VBC strategy.
Partners with Network Contracting to translate network intelligence into contracting priorities, provider targeting, reimbursement strategies, and network optimization opportunities.
Identifies and prioritizes enterprise network opportunities and develops supporting business cases.
Oversees deployment of network performance capabilities across markets, driving adoption, change management, and measurable business impact.
Evaluates emerging technologies, data sources, vendors, and industry practices to strengthen network performance capabilities.
Develops and manages the team's operating plan, talent strategy, priorities, and resource allocation.
Represents Network Performance & Strategy with executive leadership and cross-functional stakeholders.
Establishes accountability for measurable outcomes and evaluates team impact on network performance and business objectives.
Perform any other job related duties as requested.
Education and Experience: Bachelor's degree in healthcare administration, business, analytics, economics, public health, or related field required
Master's degree, MBA, MHA, MPH, or advanced quantitative degree preferred
Equivalent years of relevant work experience may be accepted in lieu of required education
Ten (10) years of progressive experience in managed care, healthcare strategy, network management, provider performance, medical economics, healthcare analytics, or related areas required
Five (5) years of experience in leadership roles required
Experience in Medicaid managed care and/or Medicare Advantage preferred
Experience with network optimization, provider performance, value-based care, reimbursement, or medical cost management preferred
Competencies, Knowledge and Skills: Demonstrated understanding of health-plan network strategy, provider performance, healthcare economics, and managed-care operations
Skilled in using advanced analytics, AI, or technology-enabled operating models to increase organizational leverage
Skilled in leading enterprise capabilities across a…