Healthfirst

Reporting to the VP Network Optimization, the Director, DSE Network Optimization Program Management is responsible for leading and distilling large negotiation programs and into distinct projects that drive the efficiency of the Healthfirst Out-of-Network (OON) provider network performance through strategic planning, insight generation, and cross-functional alignment. This role serves as an advisor and integrator across A/R Optimization, Out-of-Network (OON) and Contracting Optimization functions. The role provides decision support, performance insights, governance structure, and execution visibility to ensure optimization efforts are cohesive and aligned to enterprise priorities across enterprise teams and Delivery System Engagement. The Director synthesizes data, identifies trends and risks, drives execution and supports leadership decision-making to improve cost of care, provider experience, and network competitiveness.

Responsibilities:

• Develop and maintain the enterprise provider network optimization strategy and roadmap, aligned to organizational priorities.

• Provide structured recommendations, scenario framing, and trade-off analyses to inform decisions made by A/R, OON, and Contracting leadership.

• Translate complex data and input into clear, executive-ready insights and decision support materials.

• Monitor industry trends to inform strategic direction.

• Serve as a central coordination point across optimization functions to ensure alignment of priorities, initiatives, and performance expectations.

• Identify interdependencies, risks, and opportunities across DSE, A/R, OON, and Contracting domains.

• Promote consistency in approaches, assumptions, and performance measurement across teams.

• Helps to define standardized KPIs and performance frameworks across optimization functions.

• Deliver ongoing trend analysis, performance reporting, and risk identification to inform leadership decisions.

• Support teams in translating strategy into coordinated execution plans, without assuming operational ownership.

• Identify opportunities to improve the network optimization operating model.

• Prepare executive-level materials that frame decisions, highlight implications, and clarify trade-offs

• Develop, implement, and own tools and processes for efficient operational and reimbursement management of hospital and physician partners.  

Minimum Requirements:

• A Bachelor’s Degree in business, healthcare administration and/or certifications in operations or program management or related fields

• 8+ years of progressive experience in healthcare, including: strategy, analytics interpretation, provider network management, or operations

• Demonstrated experience in decision support, influencing decision making or transformation roles

• Ability to synthesize complex datasets into clear insights and recommendations

• Experience working with reporting tools and dashboards

• Ability to take complex business problems into clear options and recommendations

• Ability to connect performance trends to strategic implications

• Proven ability to operate effectively in matrixed environments without direct authority

• Experience with Gov’t and proprietary payor reimbursement methodologies and unit cost management

• Strong communication (both verbal and written) and organizational skills

• Ability to work collaboratively, confidently, and influentially with various levels of internal staff and external partners

• Strong data management skills with ability to manage large datasets and create standardized reports.

Preferred Qualifications:

• Master’s in Business or Health Administration

• Project Management Certification

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $154,600 - $236,555

• All Other Locations (within approved locations): $127,500 - $195,075

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.