Director, Network Strategy (Marketplace) - REMOTE

Lensa; Cincinnati (OH); Remote; USD 111,000 - 177,000; Full time

Job summary

A leading healthcare organization is seeking a Director to lead provider network strategy and development. The role involves managing a high-performing team, negotiating contracts, and ensuring network adequacy. Ideal candidates will have extensive experience in network relations and a strong understanding of managed care. Competitive benefits and compensation are offered.

Qualifications

• 8+ years in network relations and development.
• 7+ years in a network management/leadership role.

Responsibilities

• Leads market strategy and planning for provider network development.
• Manages a team to negotiate and enhance provider relationships.
• Ensures network adequacy and compliance with laws.

Skills

Negotiation

Leadership

Strategic Planning

Relationship Management

Value-Based Payment Models

Education

Bachelor's degree

MBA/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 in accordance with company standards to maintain and enhance provider networks while meeting accessibility, quality, financial, and affordability goals. 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 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 close gaps.
• Meets with key providers to ensure service levels meet or exceed expectations.
• Evaluates, negotiates, and supports larger and more complex providers in compliance with company standards while meeting accessibility, quality, financial, and cost goals.
• Leads and manages a high-performing team to develop, negotiate, contract, and enhance provider relationships, ensuring network competitiveness and profitability.
• Advances company's strategy to adopt value-based payment models; may oversee the implementation and management of value-based arrangements.
• Recruits and ensures the provider network includes a suitable mix of provider specialties to meet membership needs and growth.
• Collaborates with operations to monitor and resolve service issues, including escalated claims payments/disputes, provider demographics, contracting accuracy, and credentialing.

Job Qualifications

Required Education

Bachelor's degree

Required Experience

• 8+ years in network relations and development, including building and maintaining relationships with provider systems.
• 7+ years in a network management/leadership role, with a successful record of negotiating contracts with provider groups and accountability for results.
• Deep knowledge of reimbursement structures and payment methodologies for hospitals and providers.
• Experience with value-based contracting.
• Understanding of managed care business, regulatory/legal requirements, products, programs, strategy, and objectives.
• Knowledge of hospital and physician financial issues and leveraging technology for quality and cost improvements.
• Must reside in primary states and be able to travel up to 20% within the market to visit provider groups.

Preferred Education

MBA/Master's degree preferred

Current Molina employees interested in this position 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

• Compensation varies based on location, experience, education, and skills.

Seniority level

• Director

Employment type

• Full-time

Job function

• Information Technology

Industries

• IT Services and IT Consulting