Director, Network Strategy (Marketplace) - REMOTE

Lensa; Saint Petersburg (FL); Remote; USD 111,000 - 177,000; Full time

Job summary

A leading career site is seeking a Director to lead the development of a provider network for Molina Healthcare. This role involves managing a team, negotiating contracts, and ensuring compliance with regulations while achieving financial goals. The ideal candidate will have extensive experience in network relations and a strong educational background.

Benefits

Competitive benefits

Qualifications

• 8+ years in network relations and development.
• 7+ years in a leadership role with experience negotiating complex provider contracts.
• Deep knowledge of reimbursement structures and managed care.

Responsibilities

• Leads the market's strategy for developing the provider network.
• Manages a team to negotiate and enhance provider relationships.
• Ensures network adequacy and compliance with federal and state laws.

Skills

Network relations

Leadership

Negotiation

Provider relationship management

Value-based payment models

Education

Bachelor's degree

MBA or 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, and financial goals.

Knowledge/Skills/Abilities

• Leads the market's strategy and planning in developing the provider network, including contracting and relationship management.
• Plans and implements a geographically competitive, broad access network that meets cost and performance objectives.
• Builds out network expansion markets and addresses gaps.
• Ensures service levels meet or exceed expectations through key provider meetings.
• Supports complex providers in compliance with standards, meeting accessibility, quality, and financial goals.
• Leads a high-performing team to develop, negotiate, and enhance provider relationships, ensuring network competitiveness and profitability.
• Advances value-based payment models and oversees their implementation.
• Recruits and maintains a diverse provider network aligned with membership needs.
• 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, including building and maintaining provider system relationships.
• 7+ years in a leadership role with experience negotiating complex provider contracts.
• Deep knowledge of reimbursement structures, payment methodologies, and value-based contracting.
• Understanding of managed care, 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 or Master’s degree preferred

Current Molina employees should apply through the intranet. Molina offers competitive benefits. EOE M/F/D/V.

Pay Range: $111,893 - $176,679 annually. Actual compensation varies 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