Director, Out-of-Network Contracting

The Director, Out-of-Network Contracting will report directly to the VP of Provider Network Strategy and Optimization and will serve as the Company’s central authority for establishing, negotiating, and maintaining Out-of-Network contractual arrangements, with a primary focus on reducing OON spend through disciplined contracting strategies and network expansion opportunities. This role has end-to-end accountability for the development, negotiation, execution, and governance of all OON contractual arrangements, with a mandate to materially reduce OON spend, improve unit cost performance, and expand sustainable network access. The Director will be responsible for developing contracting solutions to address escalated OON unit cost issues and formalizing rate agreements across facility, professional, ancillary, and behavioral health providers. The function will consolidate all OON contracting activities under a single, centralized organization to drive consistency, compliance, and cost efficiency. This role will own the development and maintenance of OON contracting policies, procedures, and rate methodologies, informed by regulatory requirements, market intelligence, and network access needs. The Director will develop efficiencies that reduce reliance on episodic negotiations by converting repeat OON utilization into structured contractual arrangements, including opportunities to transition OON providers into Healthfirst’s contracted network at sustainable rates. The role will establish the long-term contracting vision, operating model, and rate strategy for OON providers, ensuring alignment with regulatory requirements, market dynamics, and Healthfirst’s affordability and access objectives.