Director, Network Strategy (Marketplace) - REMOTE

Lensa; City of Syracuse (NY); Remote; USD 111,000 - 177,000; Full time

Job summary

A leading career site is seeking a Director of Network Relations to manage and enhance provider networks for Molina Healthcare. The role involves strategic planning, team management, and contract negotiations to ensure network adequacy and compliance with regulations. Candidates should have extensive experience in network relations and a bachelor's degree, with an MBA preferred.

Qualifications

• 8+ years in network relations and development.
• 7+ years in network management/leadership role.
• Deep knowledge of reimbursement structures.

Responsibilities

• Leads market strategy for provider network development.
• Manages a team focused on provider relationships.
• Negotiates contracts to enhance provider networks.

Skills

Network Development

Negotiation

Provider Relationship Management

Value-based Payment Models

Cost Management

Education

Bachelor's degree

MBA or Master's degree preferred

Job description

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Molina Healthcare, is seeking professionals. Apply via Lensa today!

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, and financial goals.

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 meeting cost and trend management objectives.
• Builds out network expansion markets and closes gaps as needed.
• Ensures service levels meet or exceed expectations through provider engagement.
• Supports negotiation with complex providers in line with company standards, meeting accessibility, quality, and financial goals.
• Leads a high-performing team focused on developing and maintaining provider relationships for network competitiveness and profitability.
• Adopts value-based payment models and oversees their implementation.
• Ensures the provider network includes appropriate specialties to meet membership 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 building and maintaining provider system relationships.
• 7+ years in a network management/leadership role with successful contract negotiations.
• Deep knowledge of reimbursement structures and payment methodologies for hospitals and providers.
• Experience with value-based contracting.
• Understanding of managed care business, legal requirements, products, and strategies.
• Knowledge of hospital and physician financial issues and leveraging technology for quality and cost improvements.
• Ability to travel up to 20% within the primary states to visit provider groups.

Preferred Education

MBA or Master's degree preferred

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

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

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

Additional Information

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