Director - Hospital Contracting (CA Market)

This role will partner closely with the VP of Contracting to develop and execute hospital contracting strategies across the organization. The Director will lead negotiations with hospitals, health systems, and facility-based providers, ensuring competitive reimbursement arrangements, network adequacy, and alignment with organizational growth objectives. This individual will serve as a subject matter expert in managed care contracting, hospital reimbursement methodologies, delegated risk arrangements, and complex facility agreements while collaborating with key stakeholders to optimize network performance and financial outcomes. What You'll Do Lead negotiations and ongoing relationship management with hospitals, integrated delivery systems (IDS), academic medical centers, and other facility-based providers. Develop and execute hospital contracting strategies that support network expansion, market competitiveness, affordability, and financial performance. Analyze hospital utilization, reimbursement models, and financial performance to support contract negotiation strategies. Negotiate complex facility agreements, including inpatient, outpatient, behavioral health, post-acute, and ancillary service arrangements. Manage Division of Financial Responsibility (DOFR) agreements, hospital amendments, Letters of Agreement (LOAs), and corrective action plans with health plans and hospital partners. Evaluate contractual language, reimbursement structures, risk allocation provisions, and regulatory requirements to mitigate organizational risk. Serve as the primary contracting escalation point for hospital and health system partners. Collaborate with Finance, Network Management, Operations, Claims, Configuration, and Business Development teams to ensure successful implementation of hospital contract terms. Monitor hospital contract performance, identify opportunities for rate optimization, and address network access or financial performance concerns. Support value-based and risk-sharing initiatives involving hospital systems and facility partners. Prepare analyses and recommendations regarding hospital network strategy, reimbursement trends, financial impact, and market opportunities. Lead and mentor contracting staff while overseeing contract workflow and negotiation priorities. Other duties as assigned. Qualifications Education: Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field; equivalent experience considered. Experience: 5+ years of healthcare contracting experience with significant experience negotiating directly with hospitals or health systems. Experience negotiating managed care agreements and risk-based contracting arrangements. Demonstrated success negotiating managed care agreements against hospitals and health systems. Strong understanding of hospital reimbursement methodologies including DRG, per diem, case rate, APC, carve-out, and value-based payment models. Experience leading projects and teams within a managed care, health plan, MSO, IPA, or provider organization environment. Experience working with delegated risk, capitation, Restricted Knox-Keene (RKK), dual risk, global risk, MSSP, ACO, or other alternative payment arrangements. Proven ability to analyze financial models, contract language, and reimbursement structures to support negotiations. Knowledge of California managed care contracting and delegated healthcare models required. Knowledge, Skills, and Abilities Have advanced Microsoft Excel, Word, and PowerPoint skills. Have experience with EZ-CAP or similar healthcare administration and managed care platforms. 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: $135,000 - $160,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.