VP Provider Network Strategy & Contracts

Molina Healthcare; Schaumburg (IL); On-site; USD 186,000 - 280,000; Full time

Job summary

Molina Healthcare, based in Downers Grove, IL, seeks an executive leader to guide the network operations and contracting for our health plan. This role negotiates complex contracts, including alternative payment models and capitated arrangements, ensuring a robust and adequate network aligned with Molina's mission.

You will lead strategy, monitor performance, and manage provider contracts with a focus on regulatory compliance and cross-functional collaboration.

Qualifications

• At least 12 years in health care including provider network management/contracting.
• At least 10 years of senior network operations experience.
• At least 7 years management/leadership experience.
• Extensive experience in the health insurance industry.
• Strong relationships with hospitals, provider groups and IPAs.
• Expert knowledge of reimbursement methodologies across Medicaid, Medicare and Marketplace.
• Ability to navigate complex regulatory environments.
• Data-driven decision making and strong analytical abilities.
• Excellent negotiation and relationship-building capabilities.
• Ability to manage multiple tasks and deadlines.

Responsibilities

• Lead network strategy, vision and performance for the network function.
• Develop and implement provider network and contract strategies.
• Oversee contract negotiation activity and templates compliance.
• Direct negotiations of provider contracts with physicians and hospitals.
• Collaborate with legal and corporate on templates and regulatory requirements.
• Oversee plan-specific fee schedule management.
• Develop strategies to improve EDI/MASS rates.
• Coordinate with enrollment growth and cross-functional stakeholders.
• Hire, train and develop a high-performance team.
• Represent the department at senior leadership levels.

Skills

Negotiation

Leadership

Strategic thinking

Communication

Project management

Analytical skills

Cross-functional collaboration

Tools

QNXT system

Contract management software

Microsoft Office

Job description

Molina Healthcare, based in Downers Grove, IL, seeks an executive leader to guide the network operations and contracting for our health plan. This role negotiates complex contracts, including alternative payment models and capitated arrangements, ensuring a robust and adequate network aligned with Molina's mission.

You will lead strategy, monitor performance, and manage provider contracts with a focus on regulatory compliance and cross-functional collaboration.