Director, Health Plan Provider Contracts (Nevada)

Molina Healthcare; Nevada (IA); On-site; USD 102,163 - 199,219; Full time

Benefits offered by this job

Competitive benefits and compensation package

Equal Opportunity Employer

Job summary

Molina Healthcare in Nevada seeks an experienced leader to oversee provider network contracting. This role involves negotiating complex contracts and collaborating with senior leadership to enhance operational performance.

The ideal candidate has extensive experience in healthcare contracting and a strong ability to manage team performance. A competitive benefits package is offered, along with a salary range of $102,163 - $199,219 annually.

Qualifications

• At least 8 years of experience in network contracting with large provider groups.
• Experience negotiating complex provider contracts and VBP models.
• Excellent verbal and written communication skills.

Responsibilities

• Oversee the provider contracting function and lead daily operations.
• Negotiate contracts with large-scale providers to ensure quality.
• Manage network adequacy reporting for Medicare and Medicaid services.

Skills

Negotiation Skills

Analytical Skills

Organizational Skills

Communication Skills

Education

8+ years of experience in network contracting

Management experience

Tools

Microsoft Office

Job description

Job Summary

Leads and directs a team responsible for health plan provider network contracting activities. Supports network strategy and development with respect to adequacy, financial performance, and operational performance. Collaborates with senior leadership and the corporate network management team to develop and implement standardized provider contracts and contracting strategies. Also responsible for negotiating complex contracts that are strategically critical to plan success, including alternative payment models (APMs), value‑based payment (VBP) contracts, and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements.

Work Location

Nevada

Essential Job Duties

• Oversee the plan’s provider contracting function, leading daily operations and collaborating with other operational departments and functional business unit stakeholders.
• Lead negotiations of contracts with the complex provider community to achieve high‑quality, cost‑effective, and marketable providers.
• Contract or re‑contract with large‑scale entities involving custom reimbursement; execute standardized alternative payment model (APM) or value‑based payment (VBP) contracts.
• Lead initiatives and activities related to issue escalations, network adequacy, and joint operating committees (JOCs).
• Manage and report network adequacy for Medicare, Marketplace, and Medicaid services.
• In conjunction with network leadership, oversee the development of provider contracting strategies including VBP; identify specialties and geographic locations to concentrate resources for a sufficient network of participating providers that serve the health care needs of members, and identify VBP provider targets to meet company goals.
• Lead the achievement of annual savings through re‑contracting initiatives and implement cost‑control initiatives to positively influence the medical cost ratio (MCR) in each contracted region.
• Lead preparation and negotiations of provider contracts and oversee negotiations, including VBP, in alignment with established company guidelines for contracting with physicians, hospitals, and other health care providers.
• Utilize standardized contract templates and VBP/pay‑for‑performance (P4P) strategies.
• Develop and maintain reimbursement tolerance parameters across multiple specialties and geographies; oversee the development of new reimbursement models in collaboration with senior leadership.
• Communicate new contracting strategies to corporate provider network leadership.
• Utilize standardized systems to track contract negotiation activity on an ongoing basis.
• Participate on senior leadership and other committees to address the strategic goals of the department and organization.
• Oversee the maintenance of all provider contract templates, including VBP program templates; collaborate with legal and corporate network leadership to modify templates and ensure compliance with all contractual and/or regulatory requirements.
• Manage contracting relationships with area agencies and community partners to support and advance plan initiatives.
• Develop and implement contracting strategies to comply with state, federal, National Committee for Quality Assurance (NCQA), and Healthcare Effectiveness Data and Information Set (HEDIS) initiatives and regulations.
• Hire, train, manage, and evaluate team member performance—provide coaching, development, and recognition; ensure ongoing appropriate staff training, hold regular team meetings, and drive communication and collaboration.

Required Qualifications

• At least 8 years of experience in network contracting with large specialty or multispecialty provider groups, and at least 5 years of experience negotiating complex provider contracts and value‑based payment (VBP) models in a managed health care setting.
• At least 3 years of management/leadership experience.
• Experience with various managed health care provider compensation methodologies across Medicaid and Medicare lines of business, including VBP, fee‑for‑service (FFS), capitation, and various forms of risk.
• Excellent negotiation and relationship‑building capabilities.
• Ability to navigate complex regulatory environments.
• Strong data‑driven decision‑making and analytical skills.
• Strong organizational skills and attention to detail.
• Ability to work cross‑functionally with internal and external stakeholders in a highly matrixed organization.
• Ability to manage multiple tasks and deadlines effectively.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office suite and applicable software programs.

Preferred Qualifications

• Deep experience negotiating alternative payment models (APMs).
• Experience with Medicaid, Medicare, and Marketplace government‑sponsored programs.

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

Pay Range: $102,163 - $199,219 / ANNUAL

Actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level.