VP, Network Management (Work Location - Illinois)

Molina Healthcare•Long Beach, CA

10d•Onsite

About The Position

Provides executive strategy and leadership to a team responsible for network operations and contracting activities. Supports network strategy and development with respect to adequacy, financial performance, and operational performance. Responsible for negotiating complex, strategically critical contracts, including alternative payment models (APMs), value-based payment (VBP) contracts, and capitated payments for hospitals, independent physician associations (IPAs), and complex behavioral health arrangements. Establishes and maintains a distinct, high-performing, and adequate network of compassionate and culturally sensitive providers aligned with Molina's mission, vision, and values.

Requirements

At least 12 years of experience in healthcare, including provider network management/contracting, healthcare operations, and/or government-sponsored programs.
At least 10 years of senior-level network operations experience, or an equivalent combination of relevant education and experience.
At least 7 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 healthcare 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 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.
Proficiency in Microsoft Office suite and applicable software programs.

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, demonstrating accountability for performance and financial results, and keeping executive leadership apprised.
Develops and implements provider network and contract strategies, identifying specialties and geographic locations to concentrate resources for establishing a sufficient network of participating providers to serve Molina's membership and meet financial goals.
Develops and maintains a market-specific provider reimbursement strategy consistent with reimbursement tolerance parameters, overseeing the development of new reimbursement models and obtaining input from corporate and legal.
Develops and maintains a system to track contract negotiation activity, utilizing and overseeing 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.
Contributes as a key member of the senior leadership team and other committees, addressing strategic goals of the department and organization.
Oversees the maintenance of all provider contract information and templates, ensuring contracts can be configured in the QNXT system and collaborating with legal and corporate to modify templates for compliance.
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 for accurate claims payment configuration.
Oversees all provider/member problem prevention, research, and resolution, and provides oversight of the provider/member appeals and grievance process.
Coordinates with enrollment growth to ensure profitable growth compared to competitors in key provider practices.
Hires, trains, manages, and evaluates team member performance, providing coaching, development, and recognition; ensures 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.