VP, Network Management & Operations (Work Location - Michigan)

Molina Talent Acquisition

122d

About The Position

Molina Health Plan Operational Leadership roles provide overall direction and administration of the Plan's operational departments, programs, and services. Responsibilities include implementing programs that are in alignment with Molina Healthcare's strategic and operating plan; providing day-to-day leadership and management of the health plan market or product operations that mirrors the company's mission, vision, and core values; and ensuring the efficient and compliant operations of the market or product of the health plan.

Requirements

• Bachelor's Degree in Business, Health Services Administration, or related field.
• 10+ years progressive experience in Healthcare Administration, Managed Care and/or Provider Services.
• Experience managing employees.
• Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
• Superior interpretation and research skills to readily identify problems, get to the root cause, and achieve prompt resolution to problems and issues including analytical skills.

Nice To Haves

• Master's Degree in Business, Health Administration, or related field.
• Experience with Medicaid and Medicare managed care plans.

Responsibilities

• Plans, organizes, staffs, and leads all activities of the State Plan's Provider Network Management and Operations Department.
• Works with staff and senior management to develop and implement provider contracting and service strategies to contain unit cost, improve member access and enhance provider satisfaction with the Plan.
• Oversees provider credentialing, delegation oversight and provider network administration activities.
• Primary plan liaison for Claims, Member Services and other Corporate Departments.
• Develops and implements provider network and contract strategies, identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers.
• Develops and maintains a market-specific provider reimbursement strategy consistent with Reimbursement Tolerance Parameters.
• Oversees the development of new reimbursement models and obtains input from Corporate and Legal regarding these models.
• Develops and maintains a system to track contract negotiation activity on an ongoing basis.
• Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts with physicians, hospitals, and other health care providers.
• Contributes as a key member of the Senior Leadership Team and other committees addressing the strategic goals of the department and organization.
• Oversees the maintenance of all provider contract information and templates.
• Works with Legal and Corporate as needed to modify 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 Association(s) and Joint Operating Committee Management.
• Provides accountability for Delegation Oversight function in the Plan.
• Provides oversight of the Provider Network Administration area to ensure accuracy of provider information in support of accurate configuration for claims payment.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees