Offer summary

Qualifications:

Bachelor's degree required, MBA or Master's preferred., At least 8 years of experience in network relations and development., Over 7 years of leadership experience in network management, including contract negotiations., In-depth knowledge of reimbursement structures, value-based contracting, and managed care regulations..

Key responsibilities:

Lead the development and management of the provider network to ensure quality and cost efficiency.

Negotiate and maintain relationships with complex provider systems and large providers.

Develop strategies for network expansion and gap closure to meet access and quality goals.

Manage a team responsible for provider contracting, relationships, and network performance.

Job description

Job Description

Job Summary

Leads the market's strategy and planning in the successful development of the provider network, including development, contracting and management of provider relationships and communications. Manages a team of employees who develop, negotiate, contract and enhance provider networks that are high quality, cost efficient and improve the lives of our members. Develops the network, assuring network adequacy and access to member choice in compliance with federal and state laws. Negotiates and services larger and more complex market/national/group-based providers in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and affordability initiatives. Responsibilities and complexities may vary by market and may be organized by services, such as hospitals, providers: or type of contract, such as fee for service or value-based contracting.

Knowledge/Skills/Abilities

Leads the market's strategy and planning in the successful development of the provider network including development, contracting and management of provider relationships and communications
Plans, develops and implements a geographically competitive, broad access network that meets objectives for unit cost performance and trend management
Implements actions to build out network expansion markets and/or to close gaps
Meets with key providers to ensure service levels are meeting or exceeding expectations
Evaluates, negotiates and supports larger and more complex market/national/group-based providers in compliance with company standards while meeting and exceeding accessibility, quality, financial goals and cost initiatives
Leads and manages a high performing team who develop, negotiate, contract and enhance collaborative provider relationships, ensuring overall network competitiveness and profitability within market
Advances company's strategy to adopt value-based payment models; may oversee the implementation and management of value-based arrangements
Recruits and ensures provider network includes an appropriate mix of provider specialties to meet the needs and growth of membership
Collaborates with operations to monitor and ensure service issues are resolved, including escalated claims payments/disputes, provider demographics, provider contracting accuracy and credentialing.

Job Qualifications

Required Education

Bachelor's degree

Required Experience

8+ years of network relations and development, including experience building and maintaining relationships with provIder systems.
7+ years of experience in a network management/leadership role, including a successful record of negotiating contracts with individual or complex provider systems of groups and accountability for business results.
In-depth knowledge of various reimbursement structures and payment methodologies for both hospitals and providers.
Knowledge and experience with value-based contracting.
In-depth knowledge of managed care business, regulatory/legal requirements, products, programs, strategy and objectives.
Comprehensive understanding of hospital and physician financial issues and how to leverage technology to achieve quality and cost improvements for both payers and providers.
Must live in primary states and be able to travel up to 20% within market to visit high-profile provider groups/networks.

Preferred Education

MBA/Master's preferred

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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Pay Range: $111,893 - $176,679 / ANNUAL