Job Description

Job Summary
This AVP, National Ancillary Contracting & Network Strategy will have direct responsibility over strategy and negotiations for DME, dialysis, lab, vision and transportation. Corporate Network Management leadership position contributes to developing and deploying tools, templates, training and guidance for all Health Plan Network Management teams including but not limited too Contract Templates, Contract Management Process, National Contracting and the network development of new Molina Markets

Job Duties

• Develops and implements provider network and contract strategies in new Molina markets, identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a sufficient network of Participating Providers to serve the health care needs of the Plan’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). Oversee the development of new reimbursement models. Facilitates communication, oversight and approval process for Health Plan exceptions for all lines of business

• Develops and maintains a system to track Contract Negotiation activity, facilitates Health Plan implementation, utilization, compliance, develops and delivers enterprise wide training for contract management system

• Develops and authors all enterprise contract templates in conjunction with legal. Responsible for dissemination of templates as well as maintenance and updates to include state regulatory changes, operational business objectives and financial terms. Responsible to maintain language libraries for the Enterprise 

• Directs the strategy, preparation and negotiations of national provider contracts across the enterprise. Oversees negotiation of national contracts in concert with established company templates and guidelines with vendors, physicians, hospitals, and other health care providers.

of network strategic goals of the enterprise in conjunction with leadership overseeing Health Plans

• Lead and manage the development and implementation of activities for network development and contracting projects

• Direct the evaluation, review, and negotiation process for network development projects

• Support business development and new business implementation engagements across markets taking into consideration individual market circumstances, provider community, budget guidelines and available resources

• Complete negotiations with complex and major provider contracts as needed to support network objectives

• Lead the network development & contracting team during the development and implementation stages

• Monitor performance in accordance with Molina standards and guidelines. Communicate with senior management and other Molina leaders regarding network strategy and planning.

• Contributes as a key member of the Corporate Network Management Team, facilitates development
 

Job Qualifications

Required Education
Bachelor's Degree in a related field (Healthcare Management, Business Administration, etc.) or equivalent combination of years of experience in lieu of Degree.
Required Experience
10 + years experience in healthcare to include experience in provider network management
Preferred Education
Master's Degree in related field (Healthcare Management, Business Administration, etc.)

 

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.