What are the responsibilities and job description for the VP, Provider Reimbursement and Contracting position at Judi Health?
About Judi Health
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:
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 value‑based 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.
This position 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, minimizing provider hassle and improving the member experience. This leader will create the foundational methods, tools and processes for provider negotiation and lead a team to execute these contracts across the country.
Position Responsibilities
All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit 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.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:
- Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
- Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
- Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.
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 value‑based 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.
This position 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, minimizing provider hassle and improving the member experience. This leader will create the foundational methods, tools and processes for provider negotiation and lead a team to execute these contracts across the country.
Position Responsibilities
- Network Overall Optionality: Work to 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 that can be employed to evaluate and value network and contracting proposals. This includes 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. The leader should strive to develop method that are transparently comparable and can be adjudicated in a 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.
- 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.
All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit 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.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.
Salary : $250,000