Head of Network Development

InnovaCare HealthSan Antonio | November 14, 2022

The Company

Founded in 2002, InnovaCare was built through the acquisition of NAMM, a California based MSO which managed over 330,000 members upon its sale to Optum in 2012. In 2004, InnovaCare acquired MMM, a health plan in Puerto Rico, which upon its sale to Anthem, managed the care of over 550k Medicare and Medicaid members via 26 owned and affiliated IPAs.
Today, InnovaCare is a value based primary care provider committed to transforming care delivery with over 35 sites across Florida. Their integrated provider network includes primary care, specialty care such as cardiology and nephrology, telehealth, diagnostic testing, and dental.
InnovaCare now was over 150 physicians serving patients across Florida. InnovaCare offers providers and staff gain greater access to enhanced clinical tools, management expertise and other resources to ensure patients always receive the highest quality and most personalized care, from community-based providers they know and trust.

The Role

With Bain and Summit’s support, InnovaCare plans to expand its network of physicians to new markets nationally. To this support rapid expansion, the company is investing in a Head of Network Development to create and manage clinically integrated networks in new geographies, initially focused across Texas.
The Head of Network Development will be responsible for InnovaCare’s network expansion in Texas, including analyzing markets to understand which providers need to be included for both network adequacy and marketability; and identifying and reaching out to potential provider partners. This leader will support working through the negotiations to reach execution of final provider contracts with competitive reimbursement terms including global risk and other value-based contract terms; and then overseeing the onboarding and credentialing of providers and the ongoing provider relations. The position will report to the VP of Business Development and can be based remotely with travel.

Experience & Requirements

10+ years of experience in the healthcare industry with at least 5 in provider or payer network management and contracting.
• Experience building and expanding healthcare payer and provider networks in multiple geographies, ideally in Texas.
• Experience leading the end-to-end contract negotiation process for healthcare payers and multiple types of providers (e.g., physicians, hospitals, post-acute care, specialty services).
• Expert level knowledge of provider reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, Performance Based Contracting, Capitation, Bundle Payment, and other alternative payment programs.
• Experience interfacing with clinicians and executives across multiple levels in provider organizations.
• Able to assess financial implications of risk-based contracts and understand how strategies and tactics work in the marketplace and impact InnovaCare.
• Manages change through influence; capable of driving buy-in and change across a diverse set of internal stakeholders; collaborative and team-oriented.
• Polished executive presence and communication skills, including written, verbal and presentation skills; comfortable and credible with executive audiences.
• A flexible, dynamic, self-demanding and proactive individual; able to motivate him/herself and others; able to work in a fast-paced, private-equity sponsored environment.

Application Information

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Additional Questions

PierceGray is committed to running an equitable and inclusive hiring process. The questions below are modeled on EEOC questions and are optional. We are requesting this information to help us understand overall demographics in our networks, enabling continuous improvement in our outreach across communities. Any information obtained will remain confidential and will not be used for any purpose that is inconsistent with federal, state, or local law.

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