Regional Director Provider Network Management; Northeast

Regional Director Provider Network Management (Northeast) - 0574

Position Overview:

The Director, Provider Network Management is a director-level position responsible for leading provider network strategy, development, and management across CINQCARE's northeast region, with a primary focus on driving practice profitability through strategic provider partnerships and optimized financial performance. Serving as the executive contact for CINQCARE network providers participating in programs such as ACO REACH, Medicare Shared Savings Program (MSSP), and payer value-based care arrangements, this role ensures robust network growth, maximizes revenue, and aligns with CINQCARE's mission.

The ideal candidate possesses advanced expertise in finance, revenue cycle management (RCM), and value-based contracting, with a proven ability to enhance profitability while fostering high-level provider relationships and achieving regional performance goals.

• Oversee the strategic development and expansion of CINQCARE's provider network in the northeast region, recruiting primary care practices, FQHCs, specialty groups such as IPAs and PLEs, and building preferred provider networks to support ACO REACH, MSSP, and payer value-based care programs, prioritizing profitability.
• Conduct regional network gap analyses to identify opportunities for meeting recruitment targets and budgeted revenue through cost-effective growth, ensuring geographic coverage, and service accessibility in underserved communities while optimizing financial returns.
• Lead initiatives to integrate value-based contracting models that drive profitability through shared savings, risk-sharing, gain sharing and performance-based incentive.

• Serve as the primary executive contact for network providers, leading high-level discussions on program participation, contract terms, profitability goals, and strategic alignment across ACO REACH, MSSP, and payer value-based care arrangements.
• Build and maintain executive relationships with provider leaders, educating them on CINQCARE's value-based care frameworks, profitability-driven quality incentives, and profitability goals.
• Resolve complex provider issues, negotiate escalations, and promote collaboration to maximize financial performance and community impact.

• Lead financial oversight of the northeast regional network, managing profit and loss (P&L) responsibilities at the provider level, budgeting, and forecasting to ensure maximum profitability and sustainability of value-based programs.
• Optimize RCM processes within provider contracts, overseeing claims adjudication (fee reduced claims), reimbursement strategies, and revenue optimization to eliminate leakage and drive revenue growth.
• Collaborate with finance and HCE teams to analyze regional financial data, implement cost-saving measures, and develop performance-based incentives that enhance profitability while maintaining quality and other performance metrics (e.g. risk adjustment).

• Direct contract negotiations for fee-for-service, capitation, shared savings, and risk-sharing arrangements, leveraging advanced financial modeling to prioritize profitability and mitigate risks.
• Ensure contracts comply with CMS regulations for ACO REACH and MSSP, as well as payer-specific value-based care requirements, while aligning with CINQCARE's profitability objectives.
• Partner with legal, compliance, and finance teams to draft and amend terms that maximize financial outcomes and support regional growth strategies.

• Monitor regional provider performance against financial, quality, and…