AVP, National Value-Based Contracting

Molina Healthcare•Long Beach, CA

About The Position

Provides strategy and leadership to team responsible for value-based contracting (VBC) activities. Responsible for valuating, negotiating, implementing and expanding the organization’s VBC portfolio across the enterprise. Represents as a key strategic partner in collaboration with network, medical economics, risk adjustment, quality, finance, enterprise information management (EIM)/information technology (IT), and clinical leadership teams to develop and grow new value-based partnerships.

Requirements

At least 10 years of experience in network contracting, and at least 8 years experience in value-based care (VBC) contracting, or equivalent combination of relevant education and experience.
At least 5 years of management/leadership experience.
Extensive experience in the health insurance industry.
Expert level knowledge regarding reimbursement methodologies for value-based contracts, across all lines of business (Medicaid, Medicare, Marketplace).
Strong experience with various managed health care provider compensation methodologies.
Excellent negotiation and relationship building capabilities.
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.

Nice To Haves

Project Management Professional (PMP) or Six Sigma green belt certification.

Responsibilities

Supports strategy development, vision and direction for value-based contracting (VBC) across the Molina enterprise. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
Leads the organization in ideation, development, and implementation of value-based contracts (VBC) in all Molina markets, and develops strategies for growing member attribution to value-based agreements at both the national and state levels.
Identifies and negotiates value-based contracts (VBC) that lower the total cost of health care for the organization.
Contributes as a key member of the national network leadership team to facilitate development of network strategic goals for VBC in conjunction with leadership.
Recommends guidelines for value-based contracting, and provides leadership on strategic development in new markets.
Leverages expert level knowledge regarding reimbursement methodologies for value-based contracts, across all lines of business to support achievement of business goals.
Manages complex external VBC partnerships to drive value-based strategy.
Assesses internal and external risks associated with VBC, including risks related to state regulations, new/renewal RFPs, data infrastructures, internal silos/processes, etc.
Defines, proposes, and aligns numerous disparate stakeholders around a strategic unified VBC operating model that mitigates risks while enabling strategic differentiators.
Creates standards regarding VBC, including preferred, acceptable, discouraged, unacceptable (PADU) analytics, data, and reconciliation processes with providers.
Ensures alignment with key stakeholders – network (strategy and negotiation), medical economics (valuation and reconciliation), enterprise information management (EIM) (data), actuarial (review/validation), finance (review/ validation), risk adjustment, and quality.
Implements and executes the defined enterprise-wide VBC operating model.
Provides monthly reporting to applicable stakeholders related to VBC, including executive level leadership.
Maintains a strong working partnership with medical economics, network, actuary, finance, enterprise information management (EIM), and information technology (IT) to determine and implement the best processes, systems, and technology to optimize VBC efficiency and effectiveness.
Manages multiple, complex VBC and cross-enterprise projects.
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.
Some travel to markets may be required (up to 15%).