JOB SUMMARY

Leads the design, growth, and performance of the SALUS provider network. Sets network strategy in alignment with the SALUS transformation plan and translates it into physician recruitment, executed contracts, referral pathways, and measurable improvements in access across the multi-specialty clinics, urgent care centers, MiConsulta digital care network, and affiliated community provider base. Leads the development of the SALUS hub-and-spoke model, connecting SALUS owned sites with contracted and affiliated providers to strengthen specialty access, continuity of care, and appropriate referral retention. The role owns the network end to end, with accountability running from the decision to pursue a provider through executed agreement, completed credentialing, active payer participation, and ongoing network performance.

ESSENTIAL FUNCTIONS

• Network strategy and hub-and-spoke development. Lead the multi-year SALUS network strategy covering specialty mix, geographic footprint, capacity needs, and build-versus-contract decisions. Lead the development of the hub-and-spoke model connecting SALUS clinics and urgent care centers with contracted and affiliated physicians, ancillary providers, facilities, and digital care capabilities. (20%)
• Network adequacy, access, and capacity. Establish and monitor network adequacy, access, geographic coverage, and capacity priorities. Partner with Operations and Medical Leadership to assess clinic and provider capacity, monitor referral patterns and out-of-network utilization, and recommend strategies to close specialty gaps and access barriers. (10%)
• Reporting and executive communication. Maintain network performance reporting covering adequacy, access, contracting activity, recruitment pipeline, credentialing status, and referral retention. Present network updates and recommendations to the Executive Director, SALUS leadership, and Triple-S enterprise stakeholders, including board-level materials as required. (5%)
• Provider contracting and negotiation. Lead contracting with physicians, physician groups, ancillary providers, and facilities from initial outreach through negotiation, execution, and renewal. Maintain the SALUS contracting strategy, including contract structures, reimbursement approaches, standard templates, and approved negotiation parameters. (20%)
• Provider relations and retention. Maintain relationships with participating physicians and provider groups, and serve as the escalation point for provider concerns related to contracting, participation, and network operations. Monitor provider satisfaction and retention indicators and act on attrition risk. (5%)
• Provider data integrity and regulatory compliance. Own the provider data source of truth, including contracts, rates, credentialing status, specialties, locations, panel status, and effective dates, and keep it synchronized with payer rosters. Ensure compliance with CMS, ASES, Puerto Rico Insurance Code, NCQA, and applicable Triple-S enterprise requirements. (5%)
• Physician recruitment and pipeline development. Lead recruitment planning for employed, contracted, and affiliated models, prioritized by specialty gap and market demand. Develop the physician pipeline through direct outreach, professional associations, residency programs, and referral sources, and partner with Human Resources, Finance, and Medical Leadership on offers and onboarding. (15%)
• Credentialing and payer enrollment ownership. Own the credentialing and payer enrollment function end to end, including team, workflow, systems, and vendors. Hold accountability for turnaround time, first-pass accuracy, application backlog, primary source verification, the recredentialing cycle, delegated credentialing arrangements, and the revenue impact of delayed or lapsed participation. (10%)
• Value-based and risk arrangement development. Develop and negotiate value-based and risk-based arrangements, including shared savings, capitation, and performance incentives, in collaboration with Finance, Legal, Compliance, and Medical Leadership. Support network readiness for commercial, Medicare Advantage, Medicaid, capitated, and attributed populations. (5%)
• Team leadership and budget management. Lead, coach, and develop the network contracting, provider relations, credentialing, and enrollment teams. Set annual departmental goals aligned to the SALUS Six-Pillar framework and manage the departmental budget and associated forecasts. (5%)

EDUCATION

EXPERIENCE

• Bachelor's degree in Health Administration, Business Administration, Public Health, or related field required. Master's degree (MHA, MBA, MPH) strongly preferred.
  Minimum of eight years of progressive experience in provider network development, managed care contracting, or physician practice management. Minimum of three years in a leadership role with direct reports and budget accountability. Experience in the Puerto Rico healthcare market and knowledge of the local provider landscape strongly preferred. Experience with physician recruitment or practice acquisition preferred.
• Valid driver's license. CPCS or CPMSM preferred given direct ownership of the credentialing function. Managed care or healthcare contracting credentials also preferred.

LICENSES AND CERTIFICATIONS

COMPETENCIES