Director - Provider Contracting (Capitation Specialist)
Job Fit Check
Base Career helps you apply smarter for this job.
Key skills for this role
Key Skills for This Role
Full Job Posting
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 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.
About Astrana Health Management
Verified company details for this employer are not available yet.
Apply for this job in 1 click
Skip the repetitive application forms
Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.
Trusted by over 500,000 job seekers on Base Career
More from this employer
More jobs at Astrana Health Management
Senior Accountant - Tax
Alhambra, USA
Manager - Tax
Alhambra, USA
Maintenance Technician
Alhambra, USA
Risk Adjustment Coordinator - TEMP
Orange, USA
Senior Accountant - Clinics Team
Alhambra, USA