Job DescriptionJOB DESCRIPTION Provides subject matter expertise and leadership for national value-based programs (VBP) activities. Manages and leads the development and implementation of value-based programs/contracts by supporting local markets and the national value-based contracting (VBC) team. Provides support for proposal and counter-proposal development, tracks financial performance of existing VBC programs and contracts, and ensures alignment with local health plan financial forecasts and goals. Accountable for designing and implementing strategies to continuously improve financial results of existing contracts and programs while also leading a continuous process of innovation to identify new VBC opportunities relevant to local markets and lines of business.
Essential Job Duties• Collaborates directly with assigned market network leaders to identify providers for value-based contracting (VBC),
• Supports local network team and national contracting team in identification of relevant metrics and benchmarks for contracting, assists with proposal and counter-proposal preparations, assists with periodic reconciliations and data sharing processes, and supports process for setting annual targets for each value-based arranged in conjunction with national quality and risk adjustment leadership and local health plan resources.
• Leverages knowledge of local market/line of business and applicable state/federal requirements to ensure workplans for value-based contracting are sufficient to meet requirements.
• Reviews internal dashboard of value-based programs and contracts by state by line of business 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 requests for proposals (RFPs) and financial forecasts.
• Ensures internal/external VBC/reporting data and reporting is accurate; ensures local market finance partners have required information to produce accurate accounting for value-based arrangements.
• 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.
Required Qualifications - 4+ years of managed care experience - Medicaid, Medicare, Marketplace.
- 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.
- Exceptional communication, facilitation, and relationship-building skills.
- Strategic thinker with strong problem-solving and decision-making abilities.
- Excellent leadership skills, especially the 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 Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
