Director, Network Strategy (Marketplace) - REMOTE

Lensa; Green Bay (WI); Remote; USD 111,000 - 177,000; Full time

Job summary

A leading healthcare organization is seeking a Director to lead provider network strategy and management. This role involves developing and negotiating contracts, enhancing provider relationships, and ensuring compliance with regulatory requirements. The ideal candidate will have extensive experience in network relations and a strong understanding of managed care.

Qualifications

• 8+ years in network relations and development.
• 7+ years in a leadership role managing networks.
• Deep understanding of reimbursement structures.

Responsibilities

• Leads market strategy for provider network development.
• Manages a team for provider relationship enhancement.
• Negotiates complex market/national provider contracts.

Skills

Leadership

Negotiation

Provider Network Development

Contract Management

Value-Based Payment Models

Education

Bachelor's degree

MBA or Master’s degree preferred

Job description

2 days ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

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 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 market strategy for provider network development, contracting, and management.
• Develops and implements a geographically competitive, broad access network.
• Builds out network expansion markets and closes gaps.
• Ensures service levels meet or exceed expectations through provider engagement.
• Supports complex provider negotiations in compliance with standards and goals.
• Leads and manages a high-performing team to develop and maintain provider relationships.
• Advances value-based payment models and oversees their implementation.
• Recruits and maintains a diverse provider network to meet member needs.
• Collaborates with operations to resolve service issues, including claims and credentialing.

Job Qualifications

Required Education

Bachelor's degree

Required Experience

• 8+ years in network relations and development, with experience working with provider systems.
• 7+ years in a leadership role managing networks and negotiating contracts.
• Deep understanding of reimbursement structures and payment methodologies.
• Experience with value-based contracting.
• Knowledge of managed care business, regulatory/legal requirements, and strategic objectives.
• Understanding of hospital and physician financial issues and leveraging technology for quality and cost improvements.
• Ability to travel up to 20% within the primary states.

Preferred Education

MBA or Master’s degree preferred

Current Molina employees should apply through the intranet. Molina offers competitive benefits. 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.

Senior Level

Director

Employment Type

Full-time

Job Function

Information Technology

Industries

IT Services and IT Consulting