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Regional Vice President of Contracting for CarePlus

The Regional VP manages the development, operations, and results of a health plan. The Regional VP requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

The Regional VP establishes long-range goals, objectives, and plans; monitors financial and operational performance; and coordinates activities of senior managers and their respective functions. Represents the health plan externally and to governmental/external agencies. Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy.

The RVP partners closely with Medical, Network Operations, Finance, Product, Legal, and Market Leadership to deliver competitive, compliant, and high-performing provider networks across for the CarePlus Market.

Key Responsibilities
Provider Contracting & Network Strategy

• Develop and execute regional provider contracting and network strategies aligned with enterprise goals, market dynamics, and regulatory requirements.
• Lead negotiations with health systems, hospitals, physician groups, ancillary providers, and post-acute partners.
• Optimize network adequacy, access, affordability, and geographic coverage across lines of business.

Financial & Performance Management

• Accountable for medical cost management, contract yield, and provider reimbursement outcomes within the region.

• Drive performance against trend, unit cost, value-based reimbursement, and quality targets.
• Partner with Finance to manage regional budgets, forecasts, and ROI related to contracting initiatives.

Value-Based Care & Innovation

• Expand and mature value-based care (VBC) arrangements, including shared savings, full-risk, bundled payments, and alternative reimbursement models.
• Collaborate with Clinical and Quality teams to improve outcomes, STAR ratings, HEDIS measures, and provider performance.

Leadership & Talent Development

• Lead and develop a multi-layered team of contracting and network leaders.
• Build strong succession plans and foster a culture of accountability, innovation, and collaboration.
• Serve as an executive mentor and coach to regional and market-level leaders.

Market & Enterprise Collaboration

• Act as a key regional executive partner to Market Presidents, Medical Directors, and Enterprise Network leadership.
• Influence enterprise policy, contracting standards, and best practices based on regional insights.
• Represent the organization in external provider forums, industry partnerships, and strategic discussions.

Compliance & Risk Management

• Ensure full compliance with state, federal, CMS, and regulatory requirements, including network adequacy and credentialing standards.
• Partner with Legal and Compliance to oversee contract risk, disputes, and regulatory audits.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree
• 10 years of experience in the healthcare industry, with a strong preference for Medicare Advantage value-based models and 3–5 years of direct experience in the Florida market.
• Proven track record of driving operational performance improvement and Senior Leadership experience
• Proven experience developing multi-product strategy at the market level or higher.
• Excellent verbal and written communications skills
• Experience leading the end-to-end contract negotiation process through closure for all types of providers (physicians, hospitals, post-acute care facilities) and delegated specialty services.
• Comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers
• Knowledge of risk arrangements and ability to influence these arrangements.
• Solid track record of hiring and developing talent and preparing associates for roles of broader and greater responsibility
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master's or J.D. degree
• Record of success leading provider contracting and provider engagement activities for all lines of business
• Experience within national or large regional health plans (Commercial, Medicare Advantage, Medicaid).
• Demonstrated ability to lead in matrixed, highly regulated environments.
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