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.

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.