Director, Provider Contracting

🕒 2 dias atrás

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Gravie

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2013

🏥 Saúde

🛡️ Seguros

🤝 B2B

💰 $150.000.000 Private Equity Round - Gravie em 2025-05

Healthcare • Insurance • B2B

A Gravie é uma empresa de soluções de benefícios e seguros de saúde que ajuda pequenas e médias empresas, corretores e funcionários a acessar e administrar benefícios de saúde mais flexíveis e acessíveis. Seus principais produtos incluem Comfort (um plano de saúde com financiamento em nível definido), Gravie ICHRA (administração de Arranjo de Reembolso de Saúde para Cobertura Individual), Gravie Pay (suporte para custos de saúde) e Gravie Care. A empresa se concentra em capacitar PMEs a oferecer cobertura individualizada e de menor custo, além de simplificar a administração de benefícios.

Descrição

• Own the provider contracting strategy for Gravie's health plan • Lead value-based care contracting and negotiate complex network agreements • Manage provider overpayment recoupment, including outreach, resolution, Claims coordination, and Finance recovery tracking • Oversee delegated entities, including audits and corrective action plans • Serve as the network team's product and technology lead with Product and Engineering • Own new provider network contracts and launches in new markets • Ensure contracts and network operations comply with CMS, state DOI, and network adequacy requirements • Partner with Finance and Actuarial on reimbursement strategy • Analyze network adequacy and market dynamics for expansion opportunities • Serve as senior escalation point for provider and vendor contract disputes • Track industry trends and competitor positioning • Partner with executive leadership on network strategy, budgeting, and cost containment

🎯 Requisitos

• Bachelor's degree, or equivalent experience • 8+ years of experience in provider contracting, network management, or healthcare reimbursement • 5+ years of experience negotiating value-based care arrangements, including risk-based and shared savings models • 5+ years of experience independently drafting and negotiating complex healthcare contracts and delegation agreements • 5+ years of experience leading network contracting strategy and managing provider, facility, or vendor relationships • 3+ years of experience managing delegated entities, including delegate oversight, audits, and compliance • 4+ years of experience ensuring contracts and network operations comply with CMS and state insurance regulations • 2+ years of experience partnering with Product or Engineering teams to shape systems or tooling requirements • Proven track record leading new network builds or market launches from contracting through go-live • Experience launching provider networks in new geographies or markets • Experience at a small or mid-sized health plan • Familiarity with contracting or network configuration systems • Previous startup company experience • Project or program management experience • Currently authorized to work in the United States • Must answer whether employer visa sponsorship is required

🏖️ Benefícios

• Alternative medicine coverage • Flexible PTO • Up to 16 weeks paid parental leave • Paid holidays • 401k program • Transportation perks • Education reimbursement • 2 days of paid paw-ternity leave • Equity • Bonus