Director, Network Strategy (Marketplace) - REMOTE

Lensa; Bowling Green (KY); Remote; USD 111,000 - 177,000; Full time

Job summary

An established industry player is seeking a Director to lead the strategy and planning for provider network development. This role involves managing a high-performing team to negotiate contracts and enhance relationships with providers, ensuring the network meets quality, accessibility, and cost goals. The ideal candidate will have extensive experience in network relations and a deep understanding of reimbursement structures. This is a fantastic opportunity to make a significant impact in a dynamic environment, driving improvements in member care and service delivery while navigating complex market challenges.

Qualifications

• 8+ years in network relations and development.
• 7+ years in a leadership role managing networks.

Responsibilities

• Leads strategy for provider network development and management.
• Manages a team to negotiate and enhance provider relationships.

Skills

Network Development

Contract Negotiation

Leadership

Provider Relations

Value-Based Payment Models

Market Strategy

Education

Bachelor's Degree

MBA or Master's Degree

Job description

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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 to maintain and enhance provider networks while meeting accessibility, quality, financial, and affordability goals. Responsibilities may vary by market and could be organized by services or contract types.

Knowledge/Skills/Abilities

• Leads the market's strategy and planning for provider network development, contracting, and management.
• Plans and implements a geographically competitive, broad access network that meets cost and trend management objectives.
• Implements actions to expand markets and close gaps in the network.
• Engages with key providers to ensure service levels meet or exceed expectations.
• Evaluates, negotiates, and supports complex provider contracts in compliance with company standards, aiming to meet accessibility, quality, financial, and cost goals.
• Leads and manages a high-performing team to develop and negotiate provider relationships, ensuring network competitiveness and profitability.
• Supports the company's strategy to adopt value-based payment models, potentially overseeing their implementation.
• Recruits and maintains a diverse provider network to meet member needs and growth.
• Collaborates with operations to resolve service issues, including claims disputes, provider demographics, and credentialing.

Job Qualifications

Required Education

Bachelor's degree

Required Experience

• 8+ years in network relations and development, including experience working with provider systems.
• 7+ years in a leadership role managing networks, with a successful record in contract negotiations and business results.
• Deep understanding of reimbursement structures and payment methodologies for hospitals and providers.
• Experience with value-based contracting.
• Knowledge of managed care business, regulations, products, and strategies.
• Understanding hospital and physician financial issues and leveraging technology for quality and cost improvements.
• Willingness to travel up to 20% within primary states to visit provider groups.

Preferred Education

MBA or Master's degree preferred

Current Molina employees interested in this role should apply through the intranet.

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

Pay Range: $111,893 - $176,679 annually. Actual compensation may vary based on location, experience, education, and skills.

Additional Details

• Seniority level: Director
• Employment type: Full-time
• Job function: Information Technology
• Industries: IT Services and Consulting