Own the strategy, contracting, implementation, and performance management of provider network and care pathway partnerships.
Identify and evaluate new provider network opportunities.
Develop differentiated network configurations to support broker distribution.
Ensure network economics align with underwriting and pricing strategy.
Support geographic expansion with scalable network infrastructure.
Build partnerships with centers of excellence, specialty providers, and clinical programs.
Structure bundled pricing or value-based agreements.
Integrate care pathways into clinical and claims workflows.
Ensure pathways are operationally executable, measurable, and scalable.
Lead negotiations with provider groups, networks, and specialty partners.
Establish performance-based terms, SLAs, data-sharing requirements, and governance.
Align contracts with stop-loss, reimbursement, and regulatory requirements.
Coordinate with Legal and Finance through contract execution.
Partner with TPA leadership for integration into systems.
Establish implementation timelines, go-live criteria, and escalation paths.
Monitor performance post-launch and drive operational optimization.
Define and track KPIs for cost, access, utilization, and member experience.
Conduct partner performance reviews and identify improvement opportunities.
Resolve operational friction points impacting claims accuracy and member experience.
Refine network and pathway strategy based on performance data.

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