Director, Network Strategy (Marketplace) - REMOTE

Lensa; Sterling Heights (MI); Remote; USD 111,000 - 177,000; Full time

Job summary

A leading healthcare organization is seeking a Network Development Manager to lead provider network strategy and management. This role involves overseeing a team, negotiating contracts, and ensuring network adequacy while meeting accessibility and quality goals. The ideal candidate will have extensive experience in network relations and a strong understanding of reimbursement structures.

Benefits

Competitive benefits and compensation package

Qualifications

• 8+ years in network relations and development.
• 7+ years in a network management/leadership role.

Responsibilities

• Leads provider network strategy and planning.
• Manages a team for provider relationship development.
• Negotiates and enhances provider networks.

Skills

Leadership

Negotiation

Strategic Planning

Contract Management

Market Expansion

Education

Bachelor's degree

MBA or Master's degree

Job description

Job Description

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 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 and exceeding accessibility, quality, financial, and affordability goals. Responsibilities may vary by market and may be organized by services (e.g., hospitals, providers) or contract types (e.g., fee-for-service, value-based contracting).

Knowledge/Skills/Abilities

• Leads the market's strategy and planning for provider network development, contracting, and management.
• Plans and implements a geographically competitive, broad access network that meets cost performance and trend management objectives.
• Implements actions to expand markets and close gaps in the network.
• Ensures service levels meet or exceed expectations through key provider meetings.
• Evaluates, negotiates, and supports complex providers in compliance with standards, exceeding 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.
• Recruits providers to ensure a diverse and adequate network to meet membership needs.
• Collaborates with operations to resolve service issues, including claims 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 in contract negotiations and business results.
• In-depth knowledge of reimbursement structures and payment methodologies for hospitals and providers.
• Experience with value-based contracting.
• Knowledge of managed care business, regulations, products, and strategies.
• Understanding of hospital and physician financial issues and leveraging technology for quality and cost improvements.
• Ability to travel up to 20% within primary states to visit provider groups/networks.

Preferred Education

MBA or Master's degree preferred

Current Molina employees interested in this position should 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 per year. Actual compensation may vary based on location, experience, education, and skills.