Regional Vice President, Provider Network Development

Summary

Join XO Health, a health plan designed for self-insured employers, as the Regional Vice President of Provider Network Development. This leadership role is crucial to improving care quality and cost. You will lead strategic network development within a geographic region, requiring deep healthcare market understanding, exceptional leadership, and proven success in value-based care contract negotiations. Collaboration with internal and external stakeholders is key. The position demands expertise in network development and management, including value-based care contract negotiations. A competitive salary is offered, based on experience and certifications.

Requirements

• Bachelor’s degree in healthcare administration, business administration, or a related field
• Ten years of progressive leadership experience in network development, with demonstrated experience negotiating risk-based value-based care agreements
• Proven record of accomplishment of developing and implementing innovative healthcare payment models in a value-based environment. Experience with reimbursement strategy and designing alternative payment models including Capitation, Total Cost Shared Savings/Risk, and Episode Bundle Payments

Responsibilities

• Manage all aspects of key, strategic negotiations in assigned region, including analyzing publicly available market data and internal data; developing proposal presentations and letters; negotiating terms with providers; liaising with the legal team and other business areas to assess risks; drafting contract language and financial terms; and ensuring that final contracts are accurate and complete
• Identify and evaluate potential network expansion opportunities in targeted markets, considering factors such as member needs, provider quality, cost effectiveness, and market competitiveness
• Manage the accurate and timely implementation of all provider contracts, paying special attention to meeting NCQA, HEDIS, Federal, State, and other regulatory requirements
• Track and monitor all KPI’s and timelines associated with network recruiting
• Collaborate with internal teams to streamline network operations, resolve provider-related issues, and optimize network efficiency and effectiveness
• Foster strong relationships with healthcare providers, hospitals, physician groups, and other relevant stakeholders to enhance network development opportunities
• Represent the company at industry conferences, meetings, and other relevant events to stay abreast of industry trends, establish thought leadership, and identify potential partnerships

Preferred Qualifications

• Strong analytical and problem-solving skills and can interpret and utilize healthcare data to drive decision-making
• Excellent communication, negotiation, and interpersonal skills to build relationships and collaborate effectively with diverse stakeholders
• Demonstrated leadership skills to lead and manage a team effectively
• Self-assured and results oriented
• Strong financial acumen
• Commitment to the startup

Benefits

Full compensation packages are based on candidate experience and relevant certifications. $175,000 — $210,000 USD