In collaboration with our world-class data scientists and clients, the Vice President of Provider Contracting/Strategic Consulting will drive the conceptual development, quality review, and roadmap of advanced machine learning models of complex provider reimbursement programs. The person in this role will leverage a deep knowledge of issues related to healthcare reimbursement to develop data-driven innovative programs with Cogitativo’s payer clients that address contracting and delivery system pain points and be instrumental in achieving our goal of becoming a data science leader in the transformation of payer reimbursement methodologies. The VP will lead our provider contracting strategic initiatives, from documenting and prioritizing client and legislative demands, through to provider identification and engagement, program development, and contracting.
Externally, this person will drive our relationships with clients and eco-system partners and must be experienced in complex negotiations. This individual must possess the ability to persuasively communicate business concepts, value proposition, and all supporting analysis. During the machine learning development process, this person must ensure resources are in place to deliver the program by securing necessary investments from all parties (including payer clients).
Proactively identify and engage target payers who are candidates for innovative partnership models that address healthcare system needs, such as pay-for-performance, bundled payments, payments to support accountable care organizations, hospital value-based purchasing, and various other alternative payment models.
Drive collaborative design of innovative partnerships with providers that will deliver value to health systems through improved outcomes, decreased costs, or other metrics.
If required, assist our clients’ in contract development and negotiation of complex provider deals and innovative partnership models, while engaging cross-functional Cogitativo resources as necessary to get to the right answer that benefits our clients.
Leverage deep quantitative and qualitative market intelligence to ensure that machine learning models are informed by comprehensive and robust strategic analysis.
Develop and maintain strong payer/provider relationships built on trust and collaboration.
Manage expectations throughout the development and negotiation process.
Monitor local market trends relative to provider contracting and reimbursement, make recommendations to modify current processes and lead or assist with implementing changes as necessary.
Develop and maintain process, systems and explicit measures that ensure timely and accurate execution of contracting objectives.
Leverage strong knowledge of regional State and Federal regulations, laws and legislative agendas regarding healthcare industry that affects our clients and their provider network partnership models.
Drive change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.
Deliver improved client and provider satisfaction through the execution of strategic programs.
Contribute to the development of repeatable models for value-based payment development, as well as Provider Strategy leads client engagement in order to share best practices.
Bachelor’s degree required, with advanced degree preferred (specifically Masters or D. in Business, Economics, Statistics or Public Health)..
12-15 years of progressively responsible professional experience, with at least three (3) of those years in a client-facing role
Minimum 7 years healthcare payer experience in a national or large regional health plan
Comprehensive knowledge of advanced managed care principles including risk contracting, value-based contracting, and capitation.
5+ years experience with design & implementation of successful value-based payment or other alternative payer-provider arrangements.
Experience and comfort with financial modeling and detailed data analysis.
Strategic influencer who drives agreement through intellect, interpersonal and negotiation skills.
Ability to solve problems and drive issues or projects to conclusion.
Ability to function at a tactical level with a “hands on style”
Ability to work collaboratively across the organization
Spanish for meditative and contemplating, Cogitativo was created with the purpose of thinking deeply about the issues affecting our healthcare system.
WE ARE A DIFFERENT KIND OF DATA SCIENCE COMPANY
We are singularly focused on improving our healthcare system for all stakeholders – especially patients - by helping our clients make sense of complex data so they can answer their most challeng...ing questions.
Educated at some of the world’s top academic institutions, our data scientists use advanced analytical and machine learning methods. These methods provide our clients an unbiased, scientific view into their operational performance. This enables our clients to identify and reduce costly, undetected failures in their operational processes and business systems.
Our principles are simple: have a passion for healthcare, nothing is permanent and always challenge the status quo. We also believe that our distinctive capabilities shouldn’t perpetuate the inertial ‘zero sum game’ where success is measured by how much the winners take from the losers. Only in this way we will be able to positively impact the delivery of healthcare while building a successful company.
WHY DO OUR CLIENTS WORK WITH US?
As industry leaders begin to understand that behaviors drive the efficacy of the system, they are coming to realize they don’t have the in-house capabilities needed to identify the underlying attributes of these behaviors.
Cogitativo’s ‘data science as a service’ offering is a customized response to the unique questions our clients are struggling to answer. Using a challenge-based learning approach, our data scientists connect our client’s disparate, noisy data and then develop customized solutions that let our clients look deeply into their business. Just as an MRI is able to see what is happening inside the human body, our ‘data science as a service’ model quickly enables our client’s to solve their most intractable business problems.