Director, Network Strategy (Marketplace) - REMOTE

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

Job summary

A leading healthcare company is seeking a Provider Network Manager to lead strategy and planning for provider network development. This role involves managing a team, negotiating contracts, and ensuring network adequacy while meeting quality and financial goals. The ideal candidate will have extensive experience in network relations and a strong leadership background.

Benefits

Competitive benefits and compensation package

Qualifications

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

Responsibilities

• Leads market strategy and planning for provider network development.
• Manages a high-performing team to develop and maintain provider relationships.
• Negotiates and supports complex provider agreements.

Skills

Leadership

Negotiation

Contract Management

Market Strategy

Provider Relations

Education

Bachelor's degree

MBA or Master's degree

Job description

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 members. Develops the network, ensuring network adequacy and access to member choice in compliance with federal and state laws. Negotiates and services larger and more complex market, national, or group-based providers to maintain and enhance provider networks while meeting accessibility, quality, and financial goals. Responsibilities may vary by market and could be organized by services (e.g., hospitals) or contract types (e.g., fee-for-service or value-based contracting).

Knowledge/Skills/Abilities

• Leads market strategy and planning for provider network development, contracting, and management.
• Develops and implements geographically competitive networks that meet cost and trend management objectives.
• Executes actions to expand markets or close gaps in the network.
• Engages with key providers to ensure service levels meet or exceed expectations.
• Evaluates, negotiates, and supports complex provider agreements in line with company standards, aiming to meet accessibility, quality, and financial targets.
• Leads and manages a high-performing team to develop and maintain collaborative provider relationships, ensuring network competitiveness and profitability.
• Supports the company's shift toward value-based payment models, potentially overseeing related implementations.
• Recruits and maintains a diverse provider network aligned with membership needs and growth.
• Collaborates with operations to resolve service issues, including claims disputes, provider data accuracy, and credentialing.

Job Qualifications

Required Education

Bachelor's degree

Required Experience

• 8+ years in network relations and development, with experience in building and maintaining provider system relationships.
• 7+ years in a leadership role within network management, with a proven record in contract negotiations and business results.
• Deep knowledge of reimbursement structures and payment methods for hospitals and providers.
• Experience with value-based contracting.
• Understanding of managed care, legal/regulatory requirements, products, and strategies.
• Knowledge of hospital and physician financial issues and leveraging technology for quality and cost improvements.
• Willingness to travel up to 20% within primary states.

Preferred Education

MBA or Master's degree preferred

Current Molina employees interested in this role 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 per year. Actual compensation may vary based on location, experience, education, and skills.