Director of Provider Contracts & Value-Based Care

Molina Healthcare; Sparks (NV); On-site; USD 102,000 - 199,000; Full time

Job summary

Molina Healthcare in Sparks, NV is seeking a senior leader to direct the provider network contracting team. You will shape contracting strategy, negotiate complex agreements (APMs, VBP, capitated arrangements), and drive cost-management across Medicare, Medicaid, and Marketplace programs.

You will partner with senior leadership to standardize contracts, manage relationships with hospitals and physician groups, and ensure regulatory compliance while achieving annual savings and network adequacy

Qualifications

• At least 8 years in network contracting with large multispecialty provider groups.
• At least 5 years in provider contract negotiations in managed health care, including complex contracts and VBP.
• At least 3 years of management/leadership experience.
• Experience with Medicaid, Medicare, and Marketplace programs.
• Strong negotiation and relationship-building capabilities.
• Excellent communication and data-driven decision-making.
• Ability to navigate regulatory environments.
• Strong organizational skills and attention to detail.
• Ability to work cross-functionally in a matrixed organization.
• Ability to manage multiple tasks and deadlines.

Responsibilities

• Oversees the plan’s provider contracting function; responsible for leading the daily operations of the department, and collaborating with other operational departments and functional business unit stakeholders to lead or support various provider contracting functions.
• Leads negotiations of contracts with the complex provider community that result in high quality, cost-effective and marketable providers.
• Contracts/re-contracts with large scale entities involving custom reimbursement; executes standardized alternative payment model (APM) or value-based payment (VBP) contracts.
• Leads initiatives and activities issue escalations, network adequacy, and joint operating committees (JOCs).
• Manages and reports network adequacy for Medicare, Marketplace, and Medicaid services.
• In conjunction with network leadership, oversees the development of provider contracting strategies including VBP; includes identifying those specialties and geographic locations to concentrate resources for purposes of establishing a sufficient network of participating providers to serve the health care needs of members, in addition to identifying VBP provider targets to meet Molina goals.
• Leads the achievement of annual savings through recontracting initiatives, and implements cost-control initiatives to positively influence the medical cost ratio (MCR) in each contracted region.
• Leads preparation and negotiations of provider contracts and oversees negotiation of contracts, including VBP, in alignment with established company guidelines for contracting with physicians, hospitals, and other health care providers.
• Utilizes standardized contract templates and VBP/pay-for-performance (P4P) strategies.
• Develops and maintains reimbursement tolerance parameters (across multiple specialties/ geographies); oversees the development of new reimbursement models in collaboration with senior leadership.
• Communicates new contracting strategies to corporate provider network leadership.
• Utilizes standardized systems to track contract negotiation activity on an ongoing basis.
• Participates on the senior leadership and other committees to address the strategic goals of the department and organization.
• Oversees the maintenance of all provider contract templates including VBP program templates; collaborates with legal and corporate network leadership to modify contract templates, and ensures compliance with all contractual and/or regulatory requirements.
• Manages the contracting relationships with area agencies and community partners to support and advance plan initiatives.
• Develops and implements contracting strategies to comply with state, federal, National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data Information Set (HEDIS) initiatives and regulations.
• Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration.

Skills

Negotiation

Leadership

Data-driven decisions

Cross-functional collaboration

Communication

Regulatory navigation

Multitasking

Tools

Microsoft Office

Job description

Molina Healthcare in Sparks, NV is seeking a senior leader to direct the provider network contracting team. You will shape contracting strategy, negotiate complex agreements (APMs, VBP, capitated arrangements), and drive cost-management across Medicare, Medicaid, and Marketplace programs.

You will partner with senior leadership to standardize contracts, manage relationships with hospitals and physician groups, and ensure regulatory compliance while achieving annual savings and network adequacy