Director, Network Strategy (Marketplace) - REMOTE

Lensa; Omaha (NE); Remote; USD 111,000 - 177,000; Full time

Job summary

A leading healthcare company is seeking a Director of Network Relations to oversee the development and management of provider networks. This role involves strategic planning, team leadership, and contract negotiation to ensure high-quality, cost-efficient services that meet regulatory standards. The ideal candidate will have extensive experience in network relations and a strong understanding of managed care principles.

Benefits

Competitive benefits

Qualifications

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

Responsibilities

• Leads strategy and planning for provider network development.
• Manages a high-performing team for provider relationships.
• Negotiates contracts and ensures network adequacy.

Skills

Negotiation

Leadership

Strategic Planning

Provider Relationship Management

Value-Based Contracting

Education

Bachelor's degree

MBA/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, financial, and affordability goals. Responsibilities may vary by market and be organized by services or contract types.

Knowledge/Skills/Abilities

• Leads the market's strategy and planning in the development of the provider network, including development, contracting, and management of provider relationships and communications.
• Plans and implements a geographically competitive, broad access network that meets objectives for cost performance and trend management.
• 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 large and complex providers to meet accessibility, quality, and financial goals.
• Leads and manages a high-performing team to develop and negotiate provider relationships, ensuring network competitiveness and profitability.
• Supports the company's strategy to adopt value-based payment models, overseeing implementation and management of such arrangements.
• Recruits and maintains a provider network with diverse specialties to meet member 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 building and maintaining provider relationships.
• 7+ years in a network management/leadership role, including contract negotiations and business results accountability.
• Deep knowledge of reimbursement structures and payment methodologies for hospitals and providers.
• Experience with value-based contracting.
• Understanding of managed care business, regulations, 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/Master's degree preferred

Current Molina employees interested in this position 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. Compensation may vary based on location, experience, education, and skills.

Seniority level

• Director

Employment type

• Full-time

Job function

• Information Technology

Industries

• IT Services and IT Consulting