Molina Healthcare

Director, Value-Based Programs

Molina Healthcare • $120K — $150K *
Long Beach, CA 90805In-Person
Healthcare
8 - 10 years of experience
Today
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Job Overview by Ladders

Qualifications

  • 8+ years of managed care experience, including value-based programs (VBP).
  • 3+ years of management/leadership experience in program design and implementation for government healthcare.
  • Expertise in healthcare delivery environments, focusing on Medicaid, Medicare, or Marketplace programs.
  • Knowledge of VBP, risk adjustment models, HEDIS, Medicare STARS, and coding standards.
  • Strong understanding of medical economics and financial reporting principles.
  • Demonstrated leadership skills, capable of influencing cross-functional teams.
  • Proven ability to innovate within complex organizational processes.

Responsibilities

  • Design and implement strategies to enhance existing value-based initiatives.
  • Lead teams in supporting all health plans across multiple lines of business.
  • Drive corporate initiatives to support financial strategies and business goals.
  • Serve as the primary owner and executor of VBP contracts by state and LOB.
  • Identify target providers for VBC contracts and develop tailored contract terms.
  • Guide contracting strategies using needs assessments to meet VBC goals.
  • Launch and expand value-based programs in new markets and ensure forecasting alignment.

Benefits

  • Competitive benefits package.
  • Focus on professional development and top-tier talent retention.
Full Job Description
Job Description

***Remote and must live in the United States***

JOB DESCRIPTION

Job Summary

Leads and directs team responsible for value-based programs (VBP) activities. Responsible for developing and implementing value-based strategies for lines of business impacted by the regulatory risk adjustment payment model. Supports achievement of financial and business objectives through value-based reimbursement.

Essential Job Duties
  • Accountable for designing and implementing strategies to continuously improve results of existing value-based initiatives while also leading a continuous process of innovation to identify new initiatives which lead to the overall achievement of improved accuracy, compliancy and completeness in risk adjustment revenue for all government lines of business (LOB).
  • Will support all health plans and all lines of business. Could have a focus on the larger health plans.
  • Supports the strategic direction and organization of corporate initiatives to facilitate achievement of value-based financial strategies and business objectives.
  • Serves as primary owner of value-based programs (VBP) and contracts annual plan by state by line of business (LOB) development and execution.
  • In conjunction with health plan and quality and risk adjustment leadership, identifies providers for potential value-based care contracts, assists local network and corporate network teams in reaching out to targeted providers, develops suggested contract terms (financial and quality metrics and benchmarks, assignment of reporting responsibilities and functions within contract language etc.), sets annual targets for each value-based program (VBP)/value-based contract (VBC), and develops reports for local health plan resources to share on a regular cadence with providers to achieve goals.
  • Collaborates with risk adjustment to leverage the needs assessment for specific area to guide the contracting and program strategy to achieve desired VBC/VBP goals.
  • Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in requests for proposals (RFPs) and financial forecasts.
  • Presents VBC/VBP/reimbursement performance to senior leadership in monthly/quarterly leadership meetings designs an oversight process for internal monitoring of existing contracts within the Molina leadership team.
  • Ensures value-based contracting/reporting data and reporting internally and externally are accurate.
  • Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives strategy, 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.

Required Qualifications
  • At least 8 years of managed care experience, including value-based programs (VBP) experience, or equivalent combination of relevant education and experience.
  • At least 3 years of management/leadership experience.
    Experience leading value-based program and contract design, and implementation for Medicaid, Medicare, and/or Marketplace programs.
  • Experience in a complex health care delivery environment, specifically with government sponsored programs, including risk revenue management, strategy and compliance.
  • Knowledge of value- based programs (VBP), risk adjustment models, quality metrics such as Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare STARS, and coding.
  • Knowledge of medical economics and financial reporting, and ability to walk stakeholders through complex financial reconciliations.
  • Leadership skills, including ability to influence others who are not in a direct reporting line including ability to think strategically, develop vision, and execute effectively and efficiently for both near-term and long-term results.
  • Proven ability to innovate and manage complex processes across multiple functional areas.
  • Experience working in a highly matrixed organization, and proven ability to develop internal enterprise relations, and external strategic relationships.
  • Excellent verbal and written communication skills, including ability to present at an executive level to internal/external stakeholders.
  • Microsoft Office suite and applicable software program(s) proficiency.


To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package.

About Molina Healthcare

Molina Healthcare focuses exclusively on government-sponsored health care programs for families and individuals who qualify for government-sponsored health care. It contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals.

Molina Healthcare Careers

Join the dedicated team at Molina Healthcare, a leader in providing quality healthcare services to families and individuals who qualify for government-sponsored programs, including Medicaid and Medicare. As one of the most respected companies in the health services industry, Molina Healthcare offers unparalleled job opportunities aimed at empowering your career growth and professional development.

Work You’ll Do

At Molina Healthcare, you will engage in meaningful work that directly impacts lives across the country. Our team is committed to innovation in healthcare, ensuring that all members receive the best care possible. By joining us, you will collaborate with skilled professionals dedicated to our mission of providing accessible, high-quality healthcare.

Career Opportunities and Growth

Whether you are looking for your first job, seeking a leadership role, or aiming to specialize in healthcare professions, Molina Healthcare offers a range of career paths. Our job opportunities span across various functions, including clinical services, customer support, IT, project management, and more. We believe in fostering the growth of our employees through professional development, leadership training, and diversity initiatives.

Internship Programs

Kickstart your career with a Molina Healthcare internship. Our internships provide invaluable workplace experience, offering a glimpse into the healthcare industry through hands-on projects and mentorship. Interns at Molina Healthcare gain critical skills that prepare them for future employment, making them competitive candidates in the job market.

Culture and Benefits

Molina Healthcare is not just a company; it’s a community. We prioritize a culture of inclusivity and respect, where all team members are encouraged to bring their whole selves to work. Our employees enjoy comprehensive benefits, including health insurance, retirement plans, and wellness programs, all designed to support both their professional and personal lives.

Join Our Team

Explore the various positions available at Molina Healthcare and find where your skills and interests align with our needs. We are continuously hiring talented individuals who are passionate about making a difference in healthcare. Prepare your resume, sharpen your interview skills, and become part of a team that values hard work and creativity.

Stay Connected

Keep up to date with the latest at Molina Healthcare: - **Career Growth and Networking:** Advance your career through our professional development and networking opportunities. Learn from leaders and peers alike to build connections that propel your career forward. - **Innovation and Leadership:** Drive change and lead with confidence by participating in our leadership and innovation training programs.

Apply Now

Ready to take the next step in your healthcare career? Search open positions that match your skills and interests on the Molina Healthcare Jobs portal. We look for driven, curious, and compassionate team players ready to make an impact.

Stay Informed

Subscribe to Molina Healthcare job alerts and receive updates on new openings and company news directly to your inbox. Tailor your subscription to match your career preferences and stay ahead in the dynamic field of healthcare. Join Molina Healthcare, where your career is nurtured, your contributions are valued, and your growth is guaranteed.
Learn more about Molina Healthcare
Size
14,000 employees
Market Cap
$19.5 billion
Industry
Healthcare
Net Income
$673 million
Founded
1980
5 Year Trend
+9.3%
Revenue
$19.4 billion
NASDAQ
MOH
* Ladders Estimates

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