Senior Advisor Network Contract Template Governance

Job Summary

1 Position Available

The Senior Advisor Network Contract Template Governance provides strategic oversight to ensure the integrity, consistency, and strategic alignment of all agreements. This position supports a structured governance framework that promotes standardized practices.

This position provides expertise in evaluating and maintaining network contract structures across all lines of business. The Senior Advisor applies cross-functional perspective to assess downstream operational impacts and promote effective contract governance. The Senior Advisor supports consistent, compliant, and strategically aligned contracting practices across the Health Plan by maintaining comprehensive documentation, coordinating change management activities, and collaborating with stakeholders to ensure contracting processes are operationally sound and effectively implemented.

This position collaborates on the improvement of communication between the department and key stakeholders to define opportunities, identify and prioritize programs and projects based on predefined criteria (e.g. return on investment, productivity, compliance).

Provides expert advice to various teams, including program and product development, marketing, and customer service, on various relevant topics.

Duties

Maintains the integrity, consistency, and strategic alignment of all agreements, amendments, reimbursement exhibits, product addenda, delegation materials, and related documents. Establishes and administers a disciplined governance framework that defines template ownership, version control, approval authority, review cycles, change management protocols, and document retention standards. Ensures every contract reflects the organization’s business strategies, regulatory obligations, and operational capabilities, while supporting emerging network priorities and reimbursement models.

Maintains a centralized inventory of authorized templates, guaranteeing contracting teams have access to correct versions tailored to provider type, product, reimbursement methodology, and business purpose. Develops and enforces standards governing the use of templates, alternative provisions, negotiated deviations, and non-standard terms, including escalation pathways for matters requiring review from key stakeholders. Leads recurring reviews of network contract templates to ensure continued alignment with business strategies and regulatory requirements, identify opportunities to simplify and consolidate templates, reduce unnecessary variation and ambiguity, mitigate payment disputes, and minimize configuration errors and inconsistent interpretation.

Evaluates contract requirements across all provider categories. Supports the development and maintenance of contract structures appropriate for all lines of business. Partners with internal teams to ensure compensation exhibits accurately reflect approved methodologies and can be reliably operationalized.

Assesses contractual language for downstream impacts on claims adjudication, system configuration, reimbursement, authorization processes, provider data management, delegation oversight, reporting, compliance, and servicing. Identifies recurring operational issues related to contract language and facilitates root cause analyses to determine appropriate template, policy, process, or system changes, while maintaining decision logs, template inventories, change histories, and governance documentation to support disciplined contract management.

Develop practical tools to enable contracting teams to manage contract activities within established governance parameters. Collaborates with cross-functional teams across business units to ensure contract operationalization is compliant and strategically aligned, supports regulatory requirements from Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS), facilitates readiness for new payment methodologies, and ensures contracts are administratively executable and operationally sound.

Duties Continued

Provides expert advice to various business units on relevant topics within the organizational standards, national and state-wide compliance.

Evaluates the effectiveness of program implementation and provides guidance and recommends process improvement.

Communicates strategic planning outcomes and the agreed upon priorities across the organization, to include ongoing progress of priorities. 

Leads efforts to allow the company to mitigate risk such as regulatory or competitive risks through innovative business ideas and solutions.

Responsible for communicating decisions, priorities and relevant project information to appropriate levels of staff regarding business unit requests and projects and initiatives.

Responsible for sharing solution roadmaps and enterprise level strategies to drive efficiencies across the organization and with customers. Collaborates with management to develop annual budgets for respective business areas. 

Provides support in delivering programs that meet the compliance needs of the organization.

Performs other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 6 years of progressively responsible experience in managed care, health plan network management, provider contracting, contract administration, healthcare operations, legal operations, OR a related field.

Experience working with provider agreements, amendments, compensation exhibits, contract templates, or provider contracting standards within a managed healthcare environment.

Experience partnering with enterprise stakeholders on complex contractual or business matters.

Experience interpreting complex contractual provisions and translating requirements into operationally executable business processes.

Experience leading cross-functional initiatives.

Experience developing or managing governance processes, standardized business practices, policies, procedures, or enterprise controls.

Preferred:

Experience in data analysis, understanding payment rates, and managing healthcare costs.

Experience with large Medicaid, Medicare Advantage, Dual Eligible Special Needs Plan (D-SNP) supporting provider contracting across diverse provider types.

Experience with contract lifecycle management platforms, automated contracting tools, or enterprise contract repositories.

Experience with value-based payment, capitation, shared-risk, delegated, alternative payment, or other complex reimbursement arrangements.

Skills

Required:

Advanced expertise in managed care provider contracting and network management, with a deep understanding of provider agreement structures, reimbursement exhibits, amendments, addenda, and contractual terminology.

Ability to translate complex legal, regulatory, financial, and operational concepts into clear business requirements and contracting standards, ensuring clarity and compliance throughout the contracting process.

Strong governance, process-design, and change-management capabilities to build and maintain robust frameworks that support organizational excellence.

Advanced critical-thinking, problem-solving, and issue-resolution skills to assess downstream operational implications of contractual language, identify potential implementation risks, and resolve challenges proactively.

Strong facilitation and stakeholder management skills, with the ability to build consensus and drive alignment among diverse stakeholders with competing priorities.

Strong written and verbal communication skills, with the ability to develop concise, executive-level recommendations and decision materials.

Strong organizational skills and the ability to manage multiple complex initiatives simultaneously with high degree of judgment, discretion, independence, and accountability.

Ability to identify patterns across individual contracting issues and translate those insights into broader processes, template, or governance improvements, contributing to continuous organizational advancement.

Strong knowledge of managed care operations and the relationship between provider contracts and downstream functions.

Ability to clearly and effectively convey information.

Ability to adjust to changing trends, industries, and client needs.

Possess extensive, specialized knowledge in their field.

Preferred:

Knowledge of federal and state managed care regulatory requirements affecting provider agreements.

Expertise in establishing clause libraries, pre-approved alternative language, contracting playbooks, or standardized negotiation parameters.

Familiarity with claims adjudication and provider configuration processes to assess how contractual terms translate into system and payment requirements. 

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Preferred:

Contract management or related process improvement training.

Physical Requirements

Additional Information

Required:
Travel to offsite locations for work required.