Regional Vice President (RVP) Provider Solutions

Regional Vice President (RVP) Provider Solutions
Location:

Nashville, TN
Summary:
The Regional Vice President (RVP) of Provider Solutions will be responsible for strategic leadership over all provider engagement and contracting activity throughout Tennessee, including cost of care and trend management strategy, hospital negotiations, network and product design (implementation), and development/oversight of all payment innovation programs (value-based care), provider relations and primary care growth strategy throughout the state. The position holds leadership and end-to-end responsibility over WellPoint network development activities on behalf of multiple P&Ls.
Position Responsibilities:
Primary duties may include, but are not limited to:
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 Tennessee, positively impacting the affordability of respective Medicaid and Medicare Advantage health plan products.

Develops new provider networks that establish a competitive advantage, optimizing respective provider relationships to most effectively benefit health plan growth priorities.

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 ~50 associates (directors, managers, analysts, individual contributors).

Position Requirements:
BS/BA in business administration or related healthcare field and a minimum of 10 years of experience in healthcare operations, finance, underwriting, actuary, network development, and/or sales; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
MBA, MPH and/or JD preferred.

Excellent 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 the Tennessee health insurance market.

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