Director, Network Strategy (Marketplace) - REMOTE

Lensa; Everett (WA); Remote; USD 111,000 - 177,000; Full time

Job summary

A leading healthcare organization is seeking a Network Director to oversee provider network strategy and development. This role involves managing a team, negotiating contracts, and ensuring compliance with laws while improving member services. The ideal candidate will have extensive experience in network relations and leadership, with a focus on value-based payment models. Competitive benefits and compensation are offered.

Qualifications

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

Responsibilities

• Leads market strategy for provider network development.
• Manages team to enhance provider relationships and networks.
• Negotiates with complex providers to meet company standards.

Skills

Leadership

Negotiation

Provider Relations

Network Development

Value-Based Contracting

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 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 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.
• Develops and implements a geographically competitive, broad access network meeting cost and trend objectives.
• Executes actions to expand markets or address gaps in the network.
• Engages with key providers to ensure service levels meet or exceed expectations.
• Evaluates, negotiates, and supports complex providers to meet company standards and goals.
• Leads a high-performing team to develop and maintain provider relationships, ensuring network competitiveness and profitability.
• Supports the company's shift to value-based payment models and oversees related initiatives.
• Recruits and maintains a diverse provider network aligned with 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, with experience managing provider systems.
• 7+ years in a leadership role with successful contract negotiations and business results.
• Deep knowledge of reimbursement structures and payment methodologies.
• 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.
• Must reside in primary states and be able to travel up to 20% within the market.

Preferred Education

MBA or Master's degree preferred

Current Molina employees interested in this position should apply via 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 varies 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

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