RVP I Provider Solutions

BS/BA in business administration or related healthcare field
Minimum of 8 years of experience in healthcare operations, finance, underwriting, actuary, network development, and/or sales

Develops new provider networks that establish a competitive advantage, optimizing respective provider relationships to most effectively benefit health plan growth priorities
Oversees and continuously optimizes the local-market care delivery model, seeking and identifying new opportunities to enhance, enable and improve market provider account management expertise and the overarching provider experience
Delivers competitive cost-of-care trends throughout the market, positively impacting the affordability of respective Medicaid and Medicare Advantage health plan products
Aligns contracting decisions with medical management strategy, integrating quality metrics and unique (non-traditional) incentives into the overarching contracting process, shepherding a market transition from ‘fee-based’ reimbursement to a model based on quality achievement
Ensures compliance with all regulatory and accreditation standards (local and federal)
Collaborates with Product Development to recommend and implement innovative benefit plan designs in parallel with annual planning processes
Mentors, hires, trains, coaches, counsels, and evaluates the performance of approximately ~10 associates (directors, managers, analysts, individual contributors)

MBA, MPH and/or JD preferred
Experience in the Arizona health insurance market strongly preferred
Excellent network development, contracting, analytical and negotiation (listening) skills needed
Proven strategic provider partnership experience
Value-Based contracting expertise and performance management experience
Proven experience developing relationships both internal to the organization and external client facing
Experience in building out a new provider network and/or significantly expanding existing market(s)