VP, Marketplace Network Strategy and Services

JOB DESCRIPTION

Job Summary

Molina Provider Network Management and Operations jobs are responsible for network development, network adequacy and provider training and education, in alignment with Molina Healthcare‘s overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.

KNOWLEDGE/SKILLS/ABILITIES

The VP, Marketplace Network Strategy and Services is responsible for the development and implementation of enterprise-wide initiatives that deliver a cost competitive, high quality network which supports positive operational and financial outcomes.

Design successful network strategies for each state which contemplate competitor positioning, product strategies and each health plan’s goals across all Molina product lines. Successful strategies contain unit cost, broaden member access, improve network quality and enhance provider satisfaction
Work closely with the health plans’ leadership to ensure the implementation these network strategies, including maintaining compliance with all Molina, regulatory and industry standards
Develop, and oversee deployment of, Molina’s Marketplace value based care strategies
Design, maintain and implement Molina’s proprietary Marketplace fee schedule
Support and execute new health plan implementations, acquisitions, and expansions in collaboration with the Business Development Team
Coordinates with health plans to develop and deploy a Standardized Provider Engagement “Tool Kit” and training program, that supports the overall Marketplace network strategy
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.).
Responsible for the continued development and enhancement of the Marketplace Provider Network Management and Operations Department including the implementation of standard processes, policies, and procedures
Drive positive cultural changes with focus on coaching and development.

JOB QUALIFICATIONS

Required Education

Bachelor’s Degree in a related field (Business Administration, etc.,) or equivalent experience

Required 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 Education

Master’s Degree

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.

Originally posted on Himalayas

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