VP, NETWORK MANAGEMENT

Molina Healthcare; Chicago (IL); On-site; USD 186,000 - 363,000; Full time

Job summary

Molina Healthcare in Downers Grove, IL is seeking an experienced senior leader to oversee network operations and contracting. This role guides strategy for provider networks, negotiates complex contracts including APMs and capitated payments, and ensures alignment with Molina's mission and financial goals.

You will manage contract templates, oversee the QNXT configuration, build strong provider relationships, and lead a high-performing team to deliver compliant, value-based solutions across

Qualifications

• At least 12 years experience in health care including network management/contracting.
• At least 10 years of senior network operations leadership.
• Extensive health insurance industry experience.
• Strong relationships with hospitals, provider groups, IPAs.
• Expert knowledge of reimbursement methodologies across Medicaid, Medicare, Marketplace.
• Ability to operate in a highly matrixed organization and communicate with executives.

Responsibilities

• Develops and implements provider network and contract strategies to serve Molina's members and financial goals.
• Directs preparation and negotiation of provider contracts in line with templates and guidelines.
• Oversees contract management system configuration and templates with legal/compliance input.
• Leads senior leadership and cross-functional committees to align strategic goals.
• Provides oversight of provider network information, analytics, and provider relations.
• Coordinates with enrollment growth to drive profitable expansion and coaches staff.

Skills

Executive leadership

Contracting & negotiations

Strategic planning

Regulatory compliance

Cross-functional collaboration

Data-driven decision making

Tools

QNXT system

Microsoft Office

Job description

JOB DESCRIPTION

Job Summary

Provides executive strategy and leadership to team responsible for network operations and contracting activities. Supports network strategy and development with respect to adequacy, financial performance and operational performance. Also responsible for negotiating complex contracts that are strategically critical to plan/product success, including but not limited to: alternative payment models (APMs), value-based payment (VBP) contracts and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements. Establishes and maintains a distinct high-performing and adequate network of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values.

Work Location - Downers Grove, IL - Employees must reside within the state of Illinois

• Supports executive strategy development, vision and direction for the network function. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
• Develops and implements provider network and contract strategies - identifying specialties and geographic locations to concentrate resources for the purpose of establishing a sufficient network of participating providers to serve the health care needs of Molina's membership and meet established financial goals.
• Develops and maintains a market-specific provider reimbursement strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); oversees the development of new reimbursement models, and obtains input from corporate and legal on new reimbursement models.
• Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the contract management system.
• Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers.
• Contributes as a key member of the senior leadership team and other committees; responsible to address the strategic goals of the department and organization.
• Oversees the maintenance of all provider contract information, provider contract templates and ensure that all contracts negotiated can be configured in the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements.
• Oversees plan-specific fee schedule management.
• Develops strategies to improve EDI/MASS rates.
• Provides oversight of provider services and coordinates activities with provider associations and joint operating committee (JOC) leadership.
• Provides accountability for the delegation oversight function in the plan.
• Provides oversight of the provider network administration area including: provider information management and business analyses of contracts and benefits to support accurate configuration for claims payment.
• Oversees all provider/member problem prevention, research and resolution, and provides oversight of the provider/member appeals and grievance process.
• Coordinates with enrollment growth to ensure that Molina grows faster (profitable growth) than competitors in key provider practices.
• 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.
• Develops and sustains a high-performance team, dedicated to best in class solutions; responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.

Required Qualifications

• At least 12 years experience in health care to include experience in provider network management/contracting, health care operations, and/or government-sponsored programs, and at least 10 years of senior level network operations experience, or equivalent combination of relevant education and experience.
• At least 7 years management/leadership experience.
• Extensive experience in the health insurance industry.
• Track record of strong relationships with hospitals, provider groups, and independent physician associations (IPAs).
• Expert level knowledge regarding reimbursement methodologies across all lines of business (Medicaid, Medicare, Marketplace).
• Strong experience with various managed health care provider compensation methodologies.
• Excellent negotiation and relationship building capabilities.
• Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
• Superior interpretation and research skills in order to readily identify problems, get to the root-cause and achieve prompt issue/problem resolution.
• Ability to navigate complex regulatory environments.
• Data-driven decision-making skills, and strong analytical abilities.
• Strong organizational skills and attention to detail.
• Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization, and influence business decisions.
• Ability to manage multiple tasks and deadlines effectively.
• Strong project management skills.
• Excellent verbal and written communication skills, and ability to present at an executive level.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Deep experience with Medicaid, Medicare, and Marketplace managed care plans.

#LI-AC1

#PJHPO

Pay Range: $186,201.39 - $363,093 / ANNUAL

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Remote positions are U.S.-based only. Candidates must reside and be authorized to work in the United States. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Job Type

Full Time

Posting Date

Posting Date 09/25/2026