VP, Provider Reimbursement and Contracting

1 month, 1 week 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.
  • Develop differentiated network constructs, tailored ASO network solutions, and value-based provider contracts.
  • Align network and product design strategies to optimize utilization and costs.
  • Partner with senior leadership, product, IT, and operational analytics teams on Judi Care strategy and market differentiation.
  • Create methods, tools, and repeatable processes to evaluate and value network and contracting proposals.
  • Conduct market and competitive analyses to identify opportunities for differentiation, innovation, and strategic growth.
  • Develop reimbursement methods that reduce provider abrasion while supporting desired behaviors and real-time adjudication.
  • Lead value-based payment models, performance frameworks, and incentive structures that improve outcomes and reduce total medical cost.
  • Identify and cultivate high-performing provider partnerships and strategic provider networks.
  • Lead and mentor teams responsible for provider contracting, VBC program development, and network performance management.
  • Oversee negotiation and execution of provider contracts in alignment with strategic goals and regulatory requirements.

Requirements

  • MBA or related graduate degree preferred.
  • 20+ years of experience in provider network design, value-based care, and payment innovation within payer or provider organizations.
  • Proven success developing ASO network solutions and partnering with high-performing providers to reduce medical costs.
  • Strong leadership, negotiation, and stakeholder engagement skills.
  • Experience in fast-paced, high-growth, or startup environments.
  • Experience building network and contracting tools, frameworks, or analytical processes (preferred).
  • Experience with value-based payment models and provider performance management (preferred).

Benefits

  • Salary range of $250,000 to $310,000 USD.
  • Equal employment opportunity and a commitment to a diverse, inclusive workplace.
  • Privacy practices and future-opportunity data retention disclosures provided to applicants.

Interested in this position?

Apply directly on the company website

Apply Now

Similar Roles

Regional Operations Manager

Cydcor 251-1K Professional Services

Cydcor is hiring a Regional Market Operations Manager to lead field operations across an assigned territory, improve retail partner performance, and drive sales and customer experience results through independent on-the-ground execution.

50 minutes ago

Senior Director, Control Tower

ShipBob 251-1K Air Freight & Logistics

ShipBob is hiring a remote leader to oversee global control tower and merchant operations, scaling e-commerce logistics services and transforming manual processes into technology-driven operations.

E-commerce
1 hour, 24 minutes ago

Procurement Category Manager

Kaseya 1K-5K IT Services

Kaseya is hiring a Procurement Category Manager to lead strategic sourcing and category management across corporate spend areas in support of a fast-growing global IT management and cybersecurity business.

Cybersecurity
3 hours, 11 minutes ago

SVP of Operations to COO

TDS Global Solutions 51-250 Professional Services

The SVP to COO at a growing customer experience and business process outsourcing company oversees business operations and drives operational excellence, customer satisfaction, and scalable growth across client service and call center functions.

Power BI
4 hours, 15 minutes ago

You're on a roll! Sign up now to keep applying.

Sign Up

Already have an account? Log in

Used by 14,729+ remote workers