VP, Provider Reimbursement and Contracting

Position Summary The Provider Reimbursement and Contracting Leader is responsible for architecting and advancing network solutions that integrate network design, payment innovation and high-performing provider partnerships in a unified medical-pharmacy ecosystem. This position will lead the development of differentiated network constructs, tailored ASO network solutions and high performing provider contracts with valuebased innovations that improve outcomes, optimize the total cost of care and enhance employer and member value. Importantly, this role will align network and product design strategies to ensure overall utilization and costs are optimized. It will partner with senior leadership, product, IT, operational analytics teams to evolve the strategic direction and market differentiation of Judi Care, ensuring a unified, forward-thinking approach that meets complex client needs, minimizes provider hassle and improves the member experience. The leader will create foundational methods, tools and processes for provider negotiation and lead a team to execute these contracts across the country. Position Responsibilities Network Overall Optionality: Contract with a range of network options to create client optionality, from large national PPO varieties to specialty networks and tailored client constructs. Benchmarking, Analytical Tools and Processes: Create a foundation of tools and repeatable processes to evaluate and value network and contracting proposals, including market and competitive analyses to identify opportunities for differentiation, innovation, and strategic growth across network, payment and provider performance domains. Reimbursement Methods: Develop reimbursement methods that minimize provider abrasion and hassle while cultivating the right behaviors, striving for transparent, comparable methods that can be adjudicated in real-time automated manner. Value-Based Design: Lead the development of value-based payment models, performance frameworks and incentive structures that improve outcomes, reduce total medical cost and strengthen provider accountability. High-Performing Provider Partnerships: Identify and cultivate contracted relationships with high-performing providers and strategic provider networks (e.g., direct primary care or oncology networks) to unlock new pathways for medical and pharmacy cost optimization, improved utilization and enhanced clinical outcomes. Tailored ASO Networks and Geographic Micro Networks: Select geographies based on provider and ASO concentration to enable direct contracting. Build customized network solutions aligned to employer benefit design, cost-of-care goals and market needs, ensuring differentiated value for self-funded clients. Product & Solution Integration: Collaborate with product and analytics teams to embed network constructs, payment models and provider insights into scalable, market-ready offerings. Contracting Leadership: Lead and mentor teams responsible for provider contracting, VBC program development and network performance management, fostering a culture of innovation and operational excellence. Oversee negotiation and execution of provider contracts, ensuring alignment with strategic goals, regulatory requirements and performance expectations. Responsible for adherence to the Capital Rx Code of Conduct. Required Qualifications MBA or related graduate degree preferred. 20+ years of experience in provider network design, 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. Strong leadership, negotiation and stakeholder engagement skills. Experience in fast-paced, high-growth or startup environments. Salary & Location Salary Range: $250,000 — $310,000 USD (Remote, US). This range represents the low and high end of the anticipated base salary. The actual base salary will depend on several factors such as experience, knowledge, skills and location of the job. Code of Conduct All employees are responsible for adherence to the Capital Rx Code of Conduct EEO Statement Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. It is proud to provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #J-18808-Ljbffr