Director, Provider Relations and Contracting

4 weeks ago

Winter Park, Florida, United States Paradigm Full time
Location: Winter Park, FL, USA
• Tampa, FL, USA
• Texas, USA
• Illinois, USA
• Vermont, USA
• United States
• Pennsylvania, USA
Req Number: Req

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm's business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

We are seeking a Director of Provider Relations and Contracting to lead provider network strategy, contracting, and reimbursement optimization within Paradigm Risk Products. This role ensures cost-effective care delivery through provider engagement, strategic partnerships, and external pricing solutions. Additionally, this position will identify, evaluate, and manage provider network partners and external pricing vendors, including reference-based pricing solutions.

Position is remote.

Responsibilities:

Strategic Leadership & Network Optimization
  • Develop and execute strategies to optimize provider network performance and cost containment.
  • Identify, evaluate, and manage external provider network partners and reference-based pricing vendors.
  • Align provider contracting and reimbursement strategies with Paradigm financial and operational goals.
  • Collaborate with executive leadership to refine network strategy, market expansion, and provider engagement initiatives.
Provider Relations & Contracting Oversight
  • Lead provider engagement, contract negotiations, and network expansion efforts.
  • Develop policies and programs to enhance provider participation while maintaining financial sustainability.
  • Negotiate and oversee contracts with key inpatient facilities and providers, ensuring alignment with reimbursement strategies.
  • Monitor industry trends, regulatory changes, and competitive market activity to refine contracting strategies.
Vendor & Pricing Solutions Management
  • Identify, select, and oversee third-party network vendors, reference-based pricing solutions, and other external pricing tools.
  • Negotiate vendor contracts and ensure alignment with cost containment strategies.
  • Evaluate vendor performance and adjust partnerships as necessary to maximize value.
Compliance & Performance Monitoring
  • Track key performance indicators (KPIs) for network efficiency, contract effectiveness, and payment accuracy.
  • Develop and implement quality assurance measures for provider contracting, bill review, and vendor oversight.
Qualifications:
  • Bachelor's degree in healthcare administration, business, or a related field required.
  • 10+ years of experience in provider relations, network contracting, and/or reimbursement strategy.
  • Strong leadership and negotiation skills, with experience managing provider and vendor relationships.
  • Experience with inpatient facility contracting, risk-based reimbursement models, and external pricing solutions.
  • Proven ability to optimize network performance and implement cost-containment strategies.
  • Familiarity with workers' compensation, managed care, or reference-based pricing methodologies strongly preferred.
Paradigm Benefits:
  • Health and wellness : We want our people to be and stay healthy so we offer a wide variety of HMO, PPO, and HDHP health insurance options with both Cigna and Kaiser Health
  • Financial incentives : Paradigm's financial benefits also help prepare you for the future: competitive salaries, flexible spending, commuter accounts, paid life insurance, employer HSA, and 401k contributions
  • Vacation : We believe strongly that work-life balance is good for you and for our company. Our paid time off and floating-holiday programs give you the flexibility you need to live your life to the fullest
  • Learning and development: One of Paradigm's core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program
Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We're striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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