VP, Network Management & Operations - New York Health Plan (Remote in NY)

Molina Healthcare•Long Beach, CA

16h•Remote

About The Position

Provides executive strategy and leadership to the team responsible for network operations and contracting activities, supporting network strategy and development related to adequacy, financial performance, and operational performance. Oversees negotiation of complex, strategically critical contracts—including APMs, VBP arrangements, capitated payments, hospital agreements, IPAs, and behavioral health structures—while building and maintaining a high‑performing, culturally sensitive provider network aligned with Molina’s mission, vision, and values. This leader must be decisive, tactful, and highly skilled at prioritizing the most critical issues in a complex, LTSS‑heavy New York market (LHCSAs, CHHAs, SFNs). The role requires disciplined escalation, clear and timely communication during high‑pressure provider interactions, and the ability to develop a high‑performing in‑state team that prevents regulatory escalation, strengthens provider relationships, and executes on a complex adequacy and risk landscape.

Requirements

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.

Nice To Haves

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

Responsibilities

Supports executive strategy development, vision and direction for the network function. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised.
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.
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 and retention teams to ensure sustainable growth