Molina Healthcare · 8 hours ago
VP, Network Strategy and Services
Atlanta, GA
Full-time
Remote
Director/Executive
$186K/yr - $363K/yr
10+ years exp
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Responsibilities
Responsible for the continued development and enhancement of the Provider Network Management and Operations Department including the implementation of standard processes, policies, and procedures.
Work closely with the health plans leadership to ensure compliance with all Molina, regulatory and industry standards.
Support and execute new health plan implementations, acquisitions, and expansions in collaboration with the Business Development Team.
Drive positive cultural changes with focus on coaching and development.
Plans, organizes, staffs, and coordinates activities of the Provider Network Management and Operations Department.
Works with staff and Senior Management to develop and implement provider contracting strategies and provider service strategies to contain unit cost, improve member access and enhance Provider satisfaction enterprise wide.
Develop a Standardized Provider Engagement “Tool Kit”, training program and deployment plan. Develop and implement approaches to determining outcomes of tools and training programs.
Develop and oversee deployment strategy and monitoring for “Provider Profiles” and “Pay for Performance (P4P)” contracting.
In conjunction with Provider Services and Provider Contracting leaders in the Health Plans and in collaboration with the MHI AVP of Provider Contracting identify, develop, and implement approaches for performance management of Value Based Reimbursement.
Develop and refine “Clear Coverage” provider adoption strategies and assist in training of health plan staff as Clear Coverage is implemented in each Plan.
Represent Provider Engagement with Stakeholder Experience, Quality and RAMP business partners to ensure we incorporate the necessary plans to achieve positive operational and financial outcomes.
Monitor key metrics to determine Provider Engagement effectiveness and success (e.g., Provider Appeals and Grievances, Member Appeals and Grievances, CAHPs, STAR Ratings, HEDIS, HEP Completion Rates, etc.)
Qualification
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Required
Bachelor's Degree in a related field (Business Administration, etc.,) or equivalent experience
Minimum 10+ years of management and strong leadership experience
Minimum 5 years of healthcare, managed care, provider services and call center operations experience in government sponsored programs
Excellent interpersonal and communication skills (verbal and written)
Excellent leadership and managerial skills
Proven record of accomplishments in work history
Preferred
Master's Degree
Company
Molina Healthcare
Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.
10001+ employees
H1B Sponsorship
Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (33)
2022 (36)
2021 (33)
2020 (60)
Funding
Current Stage
Public CompanyTotal Funding
$1.5B2024-11-13Post Ipo Debt· $750M
2021-11-16Post Ipo Debt· $750M
2014-09-09Post Ipo Equity· $3.11M
Leadership Team
Dave Reynolds
Executive Vice President, Regional Health Plans
Debbie Simkins
Vice President, Office of the CIO
Recent News
Business Wire
2024-12-17
thefly.com
2024-12-10
2024-12-10
Company data provided by crunchbase
