Job Description
***Remote and must live in the United States***
JOB DESCRIPTION
Job Summary
Provides deep strategy and leadership for network contracting activities. Responsible for partnering with health plans/segments to develop contracting strategies for Medicaid, Medicare, and Marketplace lines of business. Leads the provider strategy, while developing and maintaining strong and consistent relationships with health plans and segments. Manages key provider relationships - both through health plan/segment partners as well as directly with key providers - and demonstrates comprehensive knowledge of provider interrelationships and the competitive landscape. Collaboratively participates in the development and management of Molina's rate approval process and fee schedules. Leverages knowledge of contracting best practices, and industry standards to support financial and business objectives.
Essential Job Duties
• Formulates network strategies including new-market entry ideation, unit cost optimization, value-based care (VBC) strategies, and other competitive network delivery solutions that enable growth and unit cost enterprise initiatives.
• Collaborates with product strategy, operations, sales, clinical, health plan, and other relevant internal stakeholders to achieve network goals.
• Develops provider negotiation strategy documents outlining key upcoming negotiations - includes provider profiles, market and network context, historical and projected financial impacts, quality and performance metrics, and strategic alignment with growth and enterprise goals; strategy documents include proposed contracting terms, internal recommendations, negotiation guardrails, and key levers to drive successful outcomes.
• Collaborates with medical economics and actuarial partners to develop detailed provider reimbursement strategies that support enterprise initiatives.
• Showcases industry experience and expertise in standard fee schedules and contracting strategies, including a strong understanding of Centers for Medicare and Medicare Services (CMS) reimbursement methodologies and commercial fee-for-service models.
• Evaluates top provider performance to guide contracting decisions and shape network strategies effectively.
• Collaborates with markets to engage on network goals and ongoing progress; reviews anticipated provider contracts for execution and ongoing provider reimbursement rate approvals, synthesizes impact and provides recommendation for leadership approval or adjustments.
• Collaborates with configuration, finance, compliance, contracting, and other teams to ensure contract language and rates meet internal policies and requirements.
• Provides support in developing and refining template contract language for both facility and professional agreements - ensuring alignment with organizational standards, regulatory requirements, and strategic contracting goals.
• Collaborates with internal stakeholders to recommend appropriate language that enhances contract clarity and operational clarity.
• Partners with internal stakeholders to support network adequacy, resolve provider issues, and improve access to care.
• Supports annual projects related to network expansion, cost-management and operational efficiency; reports on progress and escalates risks where appropriate.
• Leverages benchmarking and competitive intelligence tools to inform network strategies - demonstrating proficiency in transparency data sources for competitive positioning and utilizing Power BI and other analytical tools for data driven decision-making.
• Understands VBC models available to leverage in markets.
• Contributes to ideation and development of process improvements to essential business activities, including rate approval processes, network expansions, and strategy development.
Represents as a professional subject matter expert (SME) in all interactions with providers and internal stakeholders while driving structure, organization, and shared network goals.
Required Qualifications
• At least 8 years network contracting/network strategy experience, or equivalent combination of relevant education and experience.
• At least 3 years of management/leadership experience.
• Strong understanding of health care industry regulations.
• Deep experience with contract management software and negotiation techniques.
• Experience leading value-based program (VBP) 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.
• Fee-for-service (FFS), pay-for-performance (P4P) subject matter expertise.
• Knowledge of medical economics and financial reporting, and ability to walk stakeholders through complex financial reconciliations.
• Ability to influence others, 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.
