Regional Vice President, Provider Network Development (Minnesota)

ABOUT THE ROLE:

As a member of the Network Development Leadership Team, the RVP of Provider Network Development plays a critical role in the organization’s strategy to improve the quality and cost of care for patients. This role will lead strategic network development activities within a geographic region(s) to support the development of XO Health’s provider network.

This position requires a deep understanding of the healthcare market in the assigned geography, exceptional leadership skills, and a proven record of accomplishment in network development and management, with direct experience in value-based care contract negotiations. The successful candidate will collaborate closely with internal stakeholders, including executive leadership, operations, finance, and marketing teams, as well as external partners, such as healthcare providers, hospitals, and physician groups.

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.

EXPERIENCE AND EDUCATION REQUIRED:

• 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.

KEY PERSONAL AND PROFESSIONAL ATTRIBUTES:

• 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.