Director, Health Plan Provider Contracts – VBP & APM

Molina Healthcare; Nevada (IA); On-site; USD 102,000 - 199,000; Full time

Job summary

Molina Healthcare in Nevada seeks a leader to direct provider contracting activities, negotiating complex contracts including APMs and VBP arrangements with hospitals and IPAs. You will guide the team, develop standardized contracts, and collaborate with senior leadership to optimize network adequacy and financial performance.

The role requires extensive experience in managed care, strong negotiation skills, and the ability to manage multiple stakeholders in a regulated environment.

Qualifications

• Eight+ years in network contracting with large provider groups and five+ years in provider contract negotiations in managed care.
• Three+ years of management/leadership experience.
• Experience with VBP, FFS, capitation and risk in Medicaid/Medicare.
• Excellent negotiation and relationship-building abilities.
• Ability to navigate complex regulatory environments.
• Strong analytical and organizational skills.
• Ability to work cross-functionally in a matrixed organization.

Responsibilities

• Oversee the plan’s provider contracting function and lead daily department operations.
• Lead negotiations with complex providers to secure high-quality, cost-effective contracts.
• Manage contracts including APM and VBP for hospitals and IPAs.
• Lead network adequacy initiatives and JOCs, and report on Medicare, Marketplace, and Medicaid networks.
• Develop contracting strategies and reimbursement models in collaboration with senior leadership.
• Ensure templates and VBP/P4P strategies are standardized and compliant with regulations.

Skills

Contract negotiations

Provider contracts

Regulatory compliance

Data-driven decisions

Cross-functional collaboration

Leadership

Microsoft Office

Tools

Microsoft Office

Job description

Molina Healthcare in Nevada seeks a leader to direct provider contracting activities, negotiating complex contracts including APMs and VBP arrangements with hospitals and IPAs. You will guide the team, develop standardized contracts, and collaborate with senior leadership to optimize network adequacy and financial performance.

The role requires extensive experience in managed care, strong negotiation skills, and the ability to manage multiple stakeholders in a regulated environment.