Regional Vice President, Provider Partnership Development

Summary

Join XO Health, a health plan designed for self-insured employers, as the RVP of Provider Partnership Development (Georgia). This leadership role involves strategic planning, development, and management of XO Health's provider network in Georgia. You will lead negotiations, manage contracts, and ensure compliance with regulations. Success requires deep healthcare industry understanding, exceptional leadership, and proven network development experience in value-based care. Collaboration with internal and external stakeholders is crucial. This position offers a competitive salary and the opportunity to contribute to a company transforming healthcare.

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
• Has developed provider relationships in Georgia
• 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

• Develop and implement a comprehensive network development strategy aligned with the company's overall business goals and objectives
• Identify and evaluate potential network expansion opportunities in targeted markets, considering factors such as member needs, provider quality, cost-effectiveness, and market competitiveness
• 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
• 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
• Oversee the ongoing management and performance of the provider network, ensuring high-quality and cost-effective services for our members
• 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
• Collaborate with internal teams, including operations, finance, marketing, and product development, to ensure alignment and coordination in network-related initiatives
• Represent the company at industry conferences, meetings, and other relevant events to stay abreast of industry trends, establish thought leadership, and identify potential partnerships
• Build and lead a high-performing network development team, providing clear direction, mentorship, and guidance
• Foster a culture of collaboration, innovation, and continuous improvement
• Develop and implement training programs to enhance team members' skills and knowledge in network development and management
• Manage budget and control expenses while meeting operational, financial, and service requirements

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 — $200,000 USD