Regional Vice President, Provider Partnership Development (Georgia)

XO Health believes healthcare is fixable. Become part of the community changing the face of the industry.

XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone – from those who receive care, to those who deliver it, to those who pay for it.

We are growing a multi-disciplinary team of diverse and digitally empowered employees ready to rebuild trust in healthcare through comprehensive and unified transformation.

ABOUT THE ROLE:

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

This position requires a deep understanding of the healthcare industry, 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:

• 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.

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.
• 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.

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.

XO Health is an equal opportunity employer committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age, national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, citizenship, immigration status, protected veteran status, or any other basis prohibited under applicable federal, state or local law. XO Health promotes a drug-free workplace.