Vice President of Network Management and Operations

Join us as a Vice President of Network Management and Operations, where you'll play a crucial role in shaping our network strategies and operations! In this leadership position, you will be responsible for guiding a dynamic team focused on network operations and contracting activities. Your expertise will support our goals of network adequacy, financial performance, and operational efficiency. You will lead the negotiation of complex contracts vital for the success of our health plans, including alternative payment models and value-based payment contracts.

• Drive executive strategy development and direction for the network function, ensuring alignment with Molina's mission and values.
• Create and implement innovative provider network strategies, identifying key specialties and geographic areas to optimize resources.
• Develop and maintain provider reimbursement strategies, including oversight of new models and compliance with corporate guidelines.
• Establish a comprehensive tracking system for contract negotiation activities and oversee departmental training on contract management processes.
• Lead the negotiation of provider contracts with physicians, hospitals, and other healthcare providers, utilizing established templates and guidelines.
• Contribute to the senior leadership team, ensuring strategic alignment across departments.
• Oversee contract management including templates, compliance, and fee schedule management.
• Implement strategies to enhance EDI/MASS rates and improve provider services.
• Accountable for the delegation oversight function within the health plan.
• Manage provider network administration, ensuring accurate configurations for claims payments.
• Lead efforts in problem prevention, resolution, and oversee the appeals and grievance process.
• Coordinate enrollment growth initiatives to ensure Molina's competitive advantage.
• Recruit, train, and develop team members while fostering a high-performance culture.

• 12+ years of healthcare experience, including network management and operations.
• 10+ years of senior-level network operations experience.
• 7+ years in management or leadership roles.
• Strong relationships with hospitals, provider groups, and IPAs.
• Expert knowledge of reimbursement methodologies and managed care compensation models.
• Exceptional negotiation skills and ability to build strong relationships.
• Ability to adapt to changing environments and propose innovative solutions.
• Strong analytical skills and data-driven decision-making.
• Excellent organizational and project management skills.
• Outstanding verbal and written communication skills.
• Proficiency in Microsoft Office and relevant software applications.

• Extensive experience with Medicaid, Medicare, and Marketplace managed care plans.

Discover a rewarding career at Molina Healthcare with a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

$186,201.39 - $363,093 / ANNUAL

• Actual compensation may vary based on geographic location, work experience, education, and skill level.