134 Best risk adjustment Jobs in Bayonne, New Jersey (November 2025)

CINQCARE

Regional Director Provider Network Management (Northeast) - 0574

23 days ago

New York

Job Description Why Join CINQCARE? CINQCARE is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care. Position Overview The Director, Provider Network Management is a director-level position responsible for leading provider network strategy, development, and management across CINQCARE's northeast region, with a primary focus on driving practice profitability through strategic provider partnerships and optimized financial performance. Serving as the executive contact for CINQCARE network providers participating in programs such as ACO REACH, Medicare Shared Savings Program (MSSP), and payer value-based care arrangements, this role ensures robust network growth, maximizes revenue, and aligns with CINQCARE's mission. The ideal candidate possesses advanced expertise in finance, revenue cycle management (RCM), and value-based contracting, with a proven ability to enhance profitability while fostering high-level provider relationships and achieving regional performance goals. Key Responsibilities Strategic Network Leadership and Development • Oversee the strategic development and expansion of CINQCARE's provider network in the northeast region, recruiting primary care practices, FQHCs, specialty groups such as IPAs and PLEs, and building preferred provider networks to support ACO REACH, MSSP, and payer value-based care programs, prioritizing profitability., • Conduct regional network gap analyses to identify opportunities for meeting recruitment targets and budgeted revenue through cost-effective growth, ensuring geographic coverage, and service accessibility in underserved communities while optimizing financial returns., • Serve as the primary executive contact for network providers, leading high-level discussions on program participation, contract terms, profitability goals, and strategic alignment across ACO REACH, MSSP, and payer value-based care arrangements., • Build and maintain executive relationships with provider leaders, educating them on CINQCARE's value-based care frameworks, profitability-driven quality incentives, and profitability goals., • Lead financial oversight of the northeast regional network, managing profit and loss (P&L) responsibilities at the provider level, budgeting, and forecasting to ensure maximum profitability and sustainability of value-based programs., • Optimize RCM processes within provider contracts, overseeing claims adjudication (fee reduced claims), reimbursement strategies, and revenue optimization to eliminate leakage and drive revenue growth., • Direct contract negotiations for fee-for-service, capitation, shared savings, and risk-sharing arrangements, leveraging advanced financial modeling to prioritize profitability and mitigate risks., • Ensure contracts comply with CMS regulations for ACO REACH and MSSP, as well as payer-specific value-based care requirements, while aligning with CINQCARE's profitability objectives., • Monitor regional provider performance against financial, quality, and equity benchmarks, using advanced analytics to drive profitability through improved care delivery and cost efficiency., • Prepare executive-level reports on network performance, profitability metrics, and program compliance for CINQCARE leadership, CMS, and payer stakeholders., • Maintain expert knowledge of CMS guidelines for ACO REACH and MSSP, payer value-based care trends, and federal regulations, including Stark Law, Anti-Kickback Statute, and HIPAA, to ensure compliance while optimizing profitability., • Collaborate with market presidents, clinical, quality, finance, and HCE teams to align network strategies with CINQCARE's profitability and clinical goals., • Mentor and lead a team of network management/recruitment professionals, fostering a culture of financial accountability and innovation., • Education: Bachelor’s degree in healthcare administration, business, finance, or a related field; advanced degree (e.g., MBA, MHA, or MPH) required., • Experience:, • 7+ years in healthcare network management, provider contracting, or regional leadership, with at least 3 years in a director-level or equivalent role., • Extensive experience in finance, including P&L management, financial modeling, budgeting, and forecasting, with a focus on driving profitability in healthcare programs., • Expertise in understanding concepts of revenue cycle management (RCM), encompassing claims processing, reimbursement optimization, denial management, and revenue integrity., • Demonstrated success in value-based contracting, preferably with ACO REACH, MSSP, or payer value-based care arrangements, with a track record of improving profitability., • Track record of serving as an executive contact for providers in value-based or Medicare programs, ideally in underserved northeast communities., • Skills and Competencies:, • Advanced financial acumen with deep knowledge of healthcare economics, reimbursement methodologies (e.g., fee-for-service, capitation, shared savings), and value-based care principles, with a focus on profitability., • Strong leadership and negotiation skills to manage executive-level provider relationships and coordinate regional teams., • Proficiency in data analytics for financial performance, RCM optimization, and profitability-driven network strategy., • In-depth familiarity with CMS regulations for ACO REACH and MSSP, as well as payer contracting., • Proficient in Microsoft Office Suite, financial software, and CRM systems. At CINQCARE, we care for our team like we care for our patients—holistically. We offer flexible, comprehensive benefits so you can thrive while delivering top-notch care. • Medical Plans: Two comprehensive options offered to Team members., • 401K: 4% employer match for your future., • Dental & Vision: Flexible plans with in-network savings., • Paid Time Off: Generous PTO, holidays, and wellness time. In-office work is performed indoors in a traditional office setting with conditioned air, artificial light, and an open workspace. In this position you will need an to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business. Equal Opportunity & Reasonable Accommodation Statement CINQCARE is an Equal Opportunity Employer committed to creating an inclusive environment for all employees. We provide equal employment opportunities to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic under applicable law. If you require a reasonable accommodation during the application or employment process, please indicate this in your application or speak with your recruiter during the hiring process. Disclaimer This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Management reserves the right to modify, add, or remove duties as necessary.

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