Medical Staff Services Network Director

3 weeks ago


Sacramento, California, United States Molina Healthcare Full time
Job Summary

Molina Healthcare is seeking a highly skilled Medical Staff Services Network Director to lead our network strategy and development efforts. This role is responsible for ensuring the adequacy, financial performance, and operational performance of our provider network, in alignment with our overall mission, core values, and strategic plan.

Key Responsibilities
  • Network Strategy and Development: Develop and implement standardized provider contracts and contracting strategies in alignment with Molina Healthcare's overall mission and strategic plan.
  • Provider Contracting: Manage the Plan's Provider Contracting functions and team members, including contract negotiation and development.
  • Network Adequacy: Manage and report network adequacy for Medicare, Marketplace, and Medicaid services.
  • Cost Control Initiatives: Implement cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region.
  • Contract Negotiation: Lead preparation and negotiations of provider contracts, including Value-Based Payment (VBP) models.
  • Reimbursement Models: Develop and maintain Reimbursement Tolerance Parameters (across multiple specialties/ geographies) and oversee the development of new reimbursement models.
  • Team Management: Participate on the management team and other committees addressing the strategic goals of the department and organization.
Requirements
  • Education: Bachelor's Degree in a related field (Business Administration, etc.).
  • Experience: 7+ years experience in Healthcare Administration, Managed Care, Provider Contracting and/or Provider Services, including 2+ years in a direct or matrix leadership position.
  • Skills: Strong knowledge of managed healthcare provider compensation and VBP methodologies, primarily across Medicaid and Medicare lines of business.


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