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.
Job Info
Job Identification: 2031017
Job Category: Network Management
Posting Date: 2025-04-11T14:26:52 00:00
Job Schedule: Full time
