Director, Network Strategy (Marketplace) - REMOTE

Lensa; Detroit (MI); 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 team to negotiate and enhance provider relationships, ensuring compliance with regulations while meeting accessibility and quality goals. The ideal candidate will have extensive experience in network relations, contract negotiations, and value-based payment models. Join this dynamic organization to make a significant impact on healthcare delivery and improve member experiences through strategic provider management.

Qualifications

• 8+ years in network relations and development.
• 7+ years in a leadership role with successful contract negotiations.

Responsibilities

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

Skills

Network Relations

Contract Negotiation

Leadership

Value-Based Contracting

Provider Relationship Management

Education

Bachelor's Degree

MBA or Master's Degree

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, financial, and affordability goals. Responsibilities may vary by market and may 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 meeting cost and trend objectives.
• Builds out network expansion markets and closes gaps as needed.
• Ensures service levels meet or exceed expectations through key provider meetings.
• Evaluates, negotiates, and supports complex providers to meet company standards and goals.
• Leads and manages a high-performing team developing and maintaining provider relationships.
• Advances company's value-based payment models, overseeing implementation as needed.
• Recruits and maintains a diverse provider network to meet member needs and growth.
• Collaborates with operations to resolve service issues, including claims, provider demographics, 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 relationships.
• 7+ years in a leadership role with successful contract negotiations.
• Deep knowledge of reimbursement structures and payment methodologies.
• Experience with value-based contracting.
• Understanding of managed care, regulations, and strategy.
• Knowledge of hospital and physician financial issues and technology leverage for quality and cost improvements.
• Ability 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 competitive benefits. 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