Provider Engagement

Role overview

Nomi Health is looking for a self-directed network builder and contract negotiator to expand our employer-sponsored provider networks. You will build relationships and secure agreements with large physician organizations, ambulatory surgery centers (ASCs), freestanding facilities, and local, regional or national ancillary providers. You will manage a portfolio of strategic accounts and shift your contracting effort to priority markets where a launch, employer opportunity, or service gap requires additional provider access. This role works remotely and partners closely with colleagues across Provider Engagement, Pricing and Analytics, Legal, and Network Operations.

Provider portfolio

• Physician organizations: large primary care and multispecialty groups, specialty platforms, physician-hospital organizations (PHOs), and clinically integrated networks (CINs) with contracting authority
• Ambulatory and freestanding facilities: ASC operators and independent surgery centers, imaging centers, urgent care centers, and infusion facilities
• Local, Regional and National ancillary organizations: such as but not limited too laboratory, behavioral health, therapy, and durable medical equipment providers

Key responsibilities

• Build and grow provider networks by developing account plans, cultivating relationships with provider executives and contracting leaders, and owning negotiations from outreach and proposal through internal approval and execution.
• Negotiate reimbursement and participation terms across a wide range of provider specialties and facility types, within approved parameters. Evaluate fee schedules, Medicare-based rates, case rates, and bundled payments with Pricing and Analytics, and model expected costs using claims, utilization, and site-of-care data.
• Partner with regional and health system contracting leads to prioritize gaps by specialty, geography, appointment availability, and employer launch timing. Pursue local contracts or multi-market agreements based on where each can expand usable access.
• Articulate Nomi’s provider value proposition, including direct access to employer-sponsored populations, member steerage through benefit design where applicable, and streamlined claims and payment workflows.
• Work with Legal and Network Operations to confirm covered entities, services, and locations, validate provider rosters, and hand off credentialing, directory, rate-loading, and claims-testing requirements before go-live.

Required qualifications

• Proven experience building and expanding provider networks for a payer, third-party administrator (TPA), provider organization, or network business
• Progressive experience negotiating commercial provider agreements, with a record of closing complex contracts
• Broad negotiating experience across a wide range of provider specialties, including direct contracting with large physician groups, ASCs, freestanding facilities, or ancillary providers, and the ability to manage negotiations across multiple markets
• Working knowledge of professional and outpatient reimbursement, including CPT and HCPCS coding, fee schedules, and case rates, plus the ability to interpret claims and utilization data and explain the financial impact of contract terms
• Strong communication skills with provider executives and the ability to work through competing priorities
• Self-starter who manages their own pipeline and deadlines and works effectively in a remote environment
• Collaborative team player who coordinates with internal teams from negotiation through implementation

Preferred qualifications

• Experience with self-funded employer plans, direct-to-employer networks, tiered benefits, or site-of-care strategies
• Experience negotiating multi-site or multi-market agreements with physician platforms, ASC operators, or ancillary organizations
• Experience with a broad number of provider specialties, professional, ancillary and other.

How success is measured

• Priority network gaps closed by specialty, geography, and service line, with contracted sites available by agreed launch dates
• Target agreements executed and activated, with progress tracked against pipeline milestones and contracting timelines
• Contracted rates and projected allowed costs compared with approved benchmarks, with post-launch utilization and allowed costs reviewed alongside Analytics
• Implementation quality measured by roster accuracy, rate validation, and timely resolution of contract-related claims issues
• Completion of market specific network adequacy standards