Director, Value-Based Contracts & Programs

Molina Healthcare, Inc.; Miami Beach (FL); Remote; USD 97,000 - 190,000; Full time

Job summary

Molina Healthcare, Inc. is seeking an experienced leader to design and implement value-based contracts and programs for Medicare and Medicaid. You will lead a team, set annual targets, and collaborate with health plans and provider networks to optimize risk-adjusted revenue.

You will develop contract terms, metrics, and reporting, and present performance to senior leadership. Strong knowledge of risk adjustment, HEDIS/STARS, and financial reconciliations is essential.

Qualifications

• At least 8 years of managed care experience including value-based programs (VBP).
• At least 3 years of management/leadership experience.
• Experience leading value-based program and contract design for Medicaid/Medicare/Marketplace.
• Knowledge of risk adjustment models and quality metrics (HEDIS, STARS).
• Strong financial and analytical skills with ability to explain complex reconciliations.
• Excellent communication and executive-level presentation abilities.

Responsibilities

• Design and implement strategies to improve results of value-based initiatives.
• Lead cross-functional teams to develop and execute VBP/VBC contracts by state and LOB.
• Identify providers for value-based contracts and define contract terms and targets.
• Develop reports and dashboards to monitor performance and progress toward goals.
• Collaborate with risk adjustment to align contracting strategy with needs assessment.
• Present VBC/VBP and reimbursement performance to senior leadership monthly/quarterly.
• Ensure accuracy of contracting data and reporting both internally and externally.
• Hire, train, manage, and evaluate team performance and provide coaching.

Skills

Value-based contracts (VBC/VBP) design

Leadership & team management

Strategic thinking

VBP risk adjustment knowledge

Contract design & negotiation

Stakeholder communication

Financial reconciliation

Medicare/Medicaid experience

HEDIS/Medicare STARS knowledge

Analytical problem solving

Executive-level presentation

Tools

Microsoft Office

Job description

Molina Healthcare, Inc. is seeking an experienced leader to design and implement value-based contracts and programs for Medicare and Medicaid. You will lead a team, set annual targets, and collaborate with health plans and provider networks to optimize risk-adjusted revenue.

You will develop contract terms, metrics, and reporting, and present performance to senior leadership. Strong knowledge of risk adjustment, HEDIS/STARS, and financial reconciliations is essential.