We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary The Director of Network Strategy is responsible for developing and executing TriWest's enterprise strategy for network adequacy and network optimization across its VA Community Care Network (CCN) and TRICARE programs. This leader will establish a disciplined, data-driven approach to determining where network capacity is required, what types of providers are needed, and how large the network should be to consistently meet contractual and regulatory access standards. The Director will balance access requirements with the financial and operational costs of maintaining the network, ensuring TriWest has a network that is sufficiently broad to serve beneficiaries while avoiding unnecessary network expense and complexity.
Education & Experience Required: • Bachelor's degree in healthcare or business administration, Management Information, or related field; or equivalent background and experience
• U.S. Citizen.
• Must be able to receive a favorable interim and adjudicated final Department of Defense (DoD) background investigation.
• Five years or more of experience managing exempt staff, including hiring, coaching, performance management, and development.
• Five years or more of experience in healthcare provider network performance management, network adequacy, or network strategy. This experience may run concurrently with the management experience above.
• Demonstrated large cross-functional project/program implementation and deployment experience
• Experience with network adequacy analysis and network optimization strategies
• Experience with healthcare claims and provider data.
• Experience developing provider performance and network optimization models.
• Experience with geospatial analysis, provider access modeling, or healthcare network simulation.
• Experience using advanced analytics, predictive modeling, or business intelligence tools.
Preferred: • Master's degree in healthcare or business-related discipline
• Experience negotiating provider network and value-based healthcare delivery contracts, including the development of new relationships and opportunities that achieve desired cost optimization targets
• Experience in government programs (e.g., VA/DoD, Veteran Affairs, Medicare, Medicaid)
• Experience with supporting government healthcare proposals and/or large-scale network implementations in support of a new line of business
• Current or prior experience as a Director or above with accountability for provider network strategy, network performance, or healthcare analytics.
Key Responsibilities Network Adequacy Strategy
• Develop and maintain TriWest's enterprise framework for assessing network adequacy across VA CCN and TRICARE.
• Establish methodologies for evaluating provider access against applicable geographic, appointment availability, specialty, and other access standards.
• Identify current and projected network access gaps by market, specialty, provider type, and beneficiary population.
• Develop strategies to address actual and anticipated adequacy deficiencies before they affect beneficiary access or contractual performance.
• Incorporate beneficiary demand, utilization patterns, population demographics, provider supply, referral patterns, and network capacity into adequacy assessments.
• Partner with Network Management and Provider Contracting to translate identified gaps into targeted provider recruitment and contracting strategies.
• Monitor changes in government requirements, access standards, program design, and beneficiary demographics that may affect network requirements. People Management
• Manage and lead assigned professional staff to include recruiting, onboarding, communication, coaching, performance management, recognition and engagement of team.
Network Optimization
• Develop a strategic framework for determining the optimal size and composition of the network, balancing access, cost, provider performance, and operational complexity.
• Develop strategies to increase utilization of providers that demonstrate strong clinical performance, beneficiary experience, access, reliability, and/or financial value.
• Identify opportunities to shift volume toward providers with stronger contractual discounts and favorable economic performance. Data, Analytics & Decision Support
• Work across Network Management, Provider Contracting, Analytics, Operations, Clinical, Finance and other functions to translate network data into actionable strategies and measurable improvements.
• Support the development of analytical models and dashboards that measure network adequacy and optimization.
• Analyze provider supply and demand, claims utilization, referral patterns, reimbursement, discounts, provider performance, appointment availability, and geographic access.
• Collaborate in the development of predictive analytics to identify future network capacity requirements based on projected beneficiary enrollment, utilization, and provider supply.
• Translate complex analyses into clear recommendations for executive leadership.
.: • Establish business cases and financial analyses supporting network expansion, contraction, provider recruitment, or changes in provider utilization. RFP and Proposal Development
• Participate in RFP development and response efforts, as required, with particular responsibility for developing network-related content and strategies that are responsive to stated requirements.
• Collaborate with internal subject-matter experts and stakeholders to ensure proposals accurately address network adequacy, provider access, capacity, geographic coverage, specialty availability, and other applicable requirements.
• Develop compelling proposal content that clearly articulates TriWest's unique capabilities, market expertise, provider relationships, analytical capabilities, and demonstrated ability to build and maintain networks that meet complex customer requirements.
• Analyze RFP requirements and translate them into practical network strategies, identifying potential gaps, risks, differentiators, and opportunities to strengthen TriWest's overall proposal.
Competencies Communication / People Skills: Ability to influence or persuade others; adapts to different styles; collaborates. Translates complex analysis into executive recommendations and proposal content.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, Excel, PowerPoint, AI tools and department software applications.
Creativity / Innovation: Ability to develop unique and novel solutions to problems; views change as necessary. Designs strategic frameworks for network size and composition.
Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
Information Management: Ability to manage large amounts of complex information easily, communicates information clearly, and draws sound conclusions.
Leadership: Successfully manages different styles of employees; provides clear direction and effective coaching. Recruits, develops, and sets expectations for professional staff.
Multi-Tasking / Time Management: Prioritizes and manages actions to meet changing deadlines and requirements within a high volume, high stress environment.
Problem Solving / Analysis: Ability to solve problems through systematic analysis with sound judgment; identifies and diagnoses network access gaps by market, specialty, and population.
Team-Building / Team Player: Influences the actions and opinions of others in a positive direction and builds group commitment across Network Management, Contracting, Analytics, and Finance.
Technical Skills: Knowledge of network adequacy and access standards, geospatial analysis, provider access modeling, predictive analytics, and financial analysis of network decisions.
Working Conditions Working Conditions: • Works within a standard office environment with periodic travel; remote work eligible per TriWest telecommuting policy with periodic office attendance as needed.
• Extensive computer work with long periods of sitting.
• May work non-standard hours to support proposal deadlines, contract deliverables, and government reporting cycles.
• Regular and reliable attendance is required.
BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
TriWest job postings typically include a salary range,
which can vary based on the specific role and location, but generally this position ranges from around $171,000 to $190,000 per year.
