Director - Provider Contracting (Capitation Specialist)

Key Responsibilities

• 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.

Skills, Knowledge & Expertise

• 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.

Benefits

• 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.