Molina Healthcare

Regional Manager, Value-Based Programs - REMOTE

Molina Healthcare • $90K — $110K *
Las Cruces, NM 88001In-Person
Healthcare
Less than 5 years of experience
More than 3 months ago
Job Overview by Ladders

Qualifications

  • Bachelor's degree in Public Health, Business, Finance or a related field.
  • 4+ years of managed care experience.
  • Experience in designing and implementing value-based programs/contracts for Medicaid and/or Medicare.
  • Familiarity with risk revenue management, strategy, and compliance in healthcare environments.
  • Knowledge of value-based metrics (e.g., HEDIS, STARS) and medical coding.
  • Strong leadership skills with the ability to influence across reporting lines.
  • Proven ability to innovate and manage complex processes in matrixed organizations.

Responsibilities

  • Collaborate with local network leaders to identify providers and metrics for value-based contracting.
  • Ensure compliance with local and federal requirements for value-based programs.
  • Review and maintain accuracy of internal dashboards for value-based contracts by LOB.
  • Facilitate the launch of value-based programs in new and existing markets for improved performance.
  • Ensure accurate data reporting for value-based contracts to local market CFOs.
  • Set, communicate, and evaluate performance targets for team deliverables.
  • Build long-term relationships with market teams to enhance engagement and performance.

Benefits

  • Comprehensive health benefits package.
  • Flexible work arrangements based on job responsibilities.
  • Professional development opportunities for career advancement.
  • Collaborative work culture that encourages innovation and teamwork.
  • Supportive environment for work-life balance.
Full Job Description
Job Description

JOB DESCRIPTION

Job Summary

The Regional Manager Value Based Programs plays a critical role in the development and implementation of value-based programs and contracts by supporting both the local markets and national value based contracting team. Ensures smooth communication, supports proposal and counter-proposal development, tracks financial performance of existing programs and contracts, and ensures alignment with local health plan budgets and forecasts.

Accountable for designing and implementing a strategy to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new value based contracting opportunities relevant for the local markets and LOBs.

KNOWLEDGE/SKILLS/ABILITIES
  • Works directly with assigned market network leaders to identify providers for value-based contracting, support local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations and assists with periodic reconciliations and required data sharing processes. Assist with setting annual targets for each VBP/VBC in conjunction with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, and local health plan resources.
  • Responsible for knowledge of local market/LOB value based contracting state and federal requirements. Ensures workplans for value-based contracting are sufficient to meet requirements.
  • Responsible for reviewing internal dashboard of Value Based Programs & Contracts by state by LOB for assigned markets each period. Ensures data is accurate and any needed modifications are made on a timely basis.
  • Supports launching of value-based programs in new markets/expansion of existing markets to achieve goals in RFPs and financial forecasts.
  • Ensure Value Based Contracting/Reporting data and reporting internally and externally are accurate. Ensure local market CFOs have all required information to produce accurate accounting for value-based contracts and programs each quarter.
  • Ensures performance targets are set, clearly communicated, implemented, assessed, and completed for overall team performance.
  • Ability to manage multiple priorities and navigate ambiguity in a fast-paced environment.
  • Build and maintain long-term, collaborative relationships with market teams to drive engagement and performance.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree in Public Health, Business, Finance or equivalent combination of education and experience

Required Experience
  • 4+ years managed care experience
  • Experience participating in value-based program & contract design and implementation for marketplace, Medicaid and/or Medicare
  • Experience in a complex healthcare delivery environment, specifically with government sponsored programs, including risk revenue management, strategy, and compliance
  • Knowledge of value based programs, risk adjustment models, quality metrics such as HEDIS and STARS, knowledge of coding
  • Knowledge of medical economics and financial reporting. Must be able to walk stakeholders (internal and external) through basic financial reconciliations.
  • Excellent leadership skills, especially 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, with proven ability to develop internal enterprise relations, and external strategic relationships
  • Excellent presentation and communication skills


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.

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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