VP, Provider Reimbursement and Contracting

1 day, 1 hour ago
Full-time
Executive
Operations
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017

Description

  • Architect and advance network solutions that integrate network design, payment innovation, and provider partnerships across a unified medical-pharmacy ecosystem.
  • Contract with a range of network options to create client optionality, from large national PPOs to specialty and tailored client networks.
  • Develop benchmarking, analytical tools, and repeatable processes to evaluate and value network and contracting proposals, including market and competitive analyses.
  • Design reimbursement methods that minimize provider hassle, encourage desired behaviors, and enable transparent, real-time automated adjudication.
  • Lead development of value-based payment models, performance frameworks, and incentive structures to improve outcomes and reduce total medical cost.
  • Identify, cultivate, and manage partnerships with high-performing providers and strategic networks (e.g., direct primary care, oncology) to optimize cost, utilization, and clinical outcomes.
  • Select geographies and build tailored ASO and geographic micro-networks aligned to employer benefit design and cost-of-care goals to enable direct contracting.
  • Collaborate with product, IT, and analytics teams to embed network constructs, payment models, and provider insights into scalable, market-ready offerings.
  • Lead, mentor, and oversee teams responsible for provider contracting, VBC program development, negotiation, contract execution, and network performance management.

Requirements

  • MBA or related graduate degree preferred.
  • 20+ years of experience in provider network design, value-based care (VBC), and payment innovation within payer or provider organizations.
  • Proven success developing ASO network solutions and partnering with high-performing providers to reduce medical costs.
  • Experience developing and implementing value-based payment models, performance frameworks, and incentive structures.
  • Strong leadership, negotiation, and stakeholder engagement skills with experience managing teams and cross-functional collaboration.
  • Experience working in fast-paced, high-growth, or startup environments.
  • Demonstrated ability to create analytical tools, benchmarking processes, and market/competitive analyses for network and contracting strategies.

Benefits

  • Salary range: $250,000 — $310,000 USD.
  • Judi Health states it is an equal opportunity and diversity-valuing employer.

Interested in this position?

Apply directly on the company website

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