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Anthem, Inc. RVP I Provider Solutions (New Jersey) in Iselin, New Jersey


SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision . At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Regional Vice President, Provider Solutions (New Jersey Market)

Location : Within commuting distance to Iselin, NJ Direct Reports: 8-12

The Regional Vice President, Provider Solutions will be responsible for providing leadership to Anthem’s New Jersey network contracting and provider solutions department. As a member of Amerigroup’s New Jersey leadership team, this position will be directly accountable for designing and executing on key network strategies, cultivating market-leading relationships with providers and instituting innovative provider payment arrangements in an effort to accelerate the transition of fee-based provider spend to value-based care.

Key Responsibilities:

· Designing a cost and quality improvement plan through innovative network contracting strategies, provider partnerships and care optimization efforts.

· Overseeing and directing new network builds and market expansion projects for Amerigroup’s Medicaid, Medicare and D-SNP product lines.

· Recruiting and maintaining a best-in-class portfolio of provider networks that balance cost effectiveness with quality improvement and network adequacy / compliance requirements.

· Enabling sales and market growth priorities in partnership with local business leaders and matrix division functional heads.

· Establishing a value-based care roadmap and executing innovative reimbursement arrangements including shared risk models, capitation and episode-base bundles.

· Ensuring a superior and differentiated provider experience through close collaboration with Amerigroup’s Provider Data, Claims Operations, Clinical, and Service functional leads.

· Designing and applying financial valuation models in partnership with Healthcare Economics, Actuarial and Finance teams.

· Introducing and overseeing a portfolio of strategic activities that position Amerigroup and its provider partners to be successful in achieving annual HEDIS, stars and cost improvement measures / KPIs.

· Collaborating with digital and quality teams on the implementation of clinical data exchanges to enable a bi-directional dataflow between Amerigroup and its provider partners.

· Providing competitive intelligence and collaborating with product development areas throughout the annual business planning and bid processes.

· Attracting talent, hiring, training and developing a best-in-class Provider Solutions team.


This role requires a BS/BA in business administration or related healthcare field; 8+ 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. Masters preferred.


· Demonstrated track record of leading large-scale projects and overseeing matrixed organizational teams.

· Current knowledge of the hospital and managed care landscape within the New Jersey and Greater New York City markets.

· Strong business acumen, financial management and organizational knowledge within the healthcare delivery space.

· Strong negotiating skills and the ability to oversee complex, cross-line-of-business health system renewals.

· Exceptional written and communication skills.

· Ability to engage, collaborate with and present to senior-level executives.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS57838-New%20Jersey