AVP, Network Strategy & Services

Molina Healthcare•Long Beach, CA

About The Position

Provides strategy and leadership to team responsible for provider network management, operations, and contracting activities. Leads network strategy and development with respect to adequacy, financial performance, and operational performance. Develops network standards and resources designed to enable Molina to establish and maintain distinct high-performing networks of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values.

Requirements

At least 10 years of experience in health care to include experience in provider network management/contracting, health care operations, and/or government-sponsored programs, and at least 8 years of senior level network operations experience, or equivalent combination of relevant education and experience.
At least 5 years of 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.
Ability to navigate complex regulatory environments.
Strong data-driven decision-making skills, and 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.

Responsibilities

Supports strategy development, vision and direction for the network function.
Develops and implements provider network and contract strategies in new Molina markets.
Develops and maintains a market-specific provider reimbursement strategies consistent with reimbursement tolerance parameters.
Oversees the development of new reimbursement models.
Develops and enhances the provider network management and operations function.
Develops a standardized provider engagement “tool kit”, training program and deployment plan.
Collaborates closely with health plans leadership to ensure compliance with all Molina, regulatory and industry standards.
Supports and executes new health plan implementations, acquisitions and expansions.
Collaborates with senior leadership, health plan leadership, and collaborating functions to develop and implement provider contracting strategies and provider service strategies.
Develops and oversees deployment strategy and monitoring for “provider profiles” and “pay-for-performance (P4P)” contracting.
Develops and implements approaches for performance management of value-based reimbursement.
Develops and refines “clear coverage” provider adoption strategies and assists in training of health plan staff.
Represents provider engagement with stakeholder experience, quality and RAMP business partners.
Develops and maintains a system to track contract negotiation activities.
Develops and authors all enterprise contract templates in conjunction with legal.
Directs the strategy, preparation and negotiations of national provider contracts across the enterprise.
Monitors key metrics to determine provider engagement effectiveness and success.
Leads and manages the development and implementation of activities for network development and contracting projects.
Directs the evaluation, review, and negotiation processes for network development projects.
Supports business development and new business implementation engagements across markets.
Completes negotiations with complex and major provider contracts as needed.
Leads the network development and contracting teams during the development and implementation stages.
Monitors performance in accordance with Molina standards and guidelines.
Contributes as a key member of the corporate network leadership team.
Hires, trains, manages and evaluates team member performance.
Develops and sustains a high-performance team, dedicated to best in class solutions.