Director, Network Strategy (Marketplace) - REMOTE

Lensa; Phoenix (AZ); Remote; USD 111,000 - 177,000; Full time

Job summary

A leading career site is seeking a Director for network relations at Molina Healthcare. This role involves strategic planning, team management, and contract negotiation to enhance provider networks while ensuring compliance with regulations. The ideal candidate will have extensive experience in network management and a strong understanding of reimbursement structures.

Qualifications

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

Responsibilities

• Leads market strategy and planning for provider network development.
• Manages a team developing and enhancing provider relationships.
• Negotiates contracts with larger and more complex providers.

Skills

Negotiation

Leadership

Strategic Planning

Network Development

Value-based Contracting

Education

Bachelor's degree

MBA/Master's degree preferred

Job description

2 days ago Be among the first 25 applicants

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, and financial goals.

Responsibilities and complexities may vary by market and may be organized by services, such as hospitals, providers, or type of contract, such as fee-for-service or value-based contracting.

Knowledge/Skills/Abilities

• Leads the market's strategy and planning in developing the provider network, including development, contracting, and management of provider relationships and communications.
• Plans, develops, and implements a geographically competitive, broad access network that meets objectives for unit cost performance and trend management.
• Implements actions to build out network expansion markets and/or to close gaps.
• Meets with key providers to ensure service levels meet or exceed expectations.
• Evaluates, negotiates, and supports larger and more complex providers in compliance with company standards while meeting accessibility, quality, financial, and cost objectives.
• Leads and manages a high-performing team developing, negotiating, contracting, and enhancing provider relationships to ensure network competitiveness and profitability.
• Advances company's strategy to adopt value-based payment models and may oversee their implementation.
• Recruits and ensures the provider network includes a suitable mix of specialties to meet membership needs and growth.
• Collaborates with operations to monitor and resolve service issues, including claims payments/disputes, provider demographics, contracting accuracy, and credentialing.

Job Qualifications

Required Education

Bachelor's degree

Required Experience

• 8+ years in network relations and development, including building and maintaining provider system relationships.
• 7+ years in a network management/leadership role, with a successful record of negotiating contracts with provider groups and accountability for business results.
• 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.
• Must reside in primary states and be able to travel up to 20% within the market.

Preferred Education

MBA/Master's degree preferred

If you are a current Molina employee interested in this position, please 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 / annual. 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 IT Consulting