VP, Network Management & Operations - New York Health ...

Position Summary Provides executive strategy and leadership to the team responsible for network operations and contracting activities, supporting network strategy and development related to adequacy, financial performance, and operational performance. Oversees negotiation of complex, strategically critical contractsu2014including APMs, VBP arrangements, capitated payments, hospital agreements, IPAs, and behavioral health structuresu2014while building and maintaining a highu2011performing, culturally sensitive provider network aligned with Molinau2019s mission, vision, and values. This leader must be decisive, tactful, and highly skilled at prioritizing the most critical issues in a complex, LTSSu2011heavy New York market (LHCSAs, CHHAs, SFNs). The role requires disciplined escalation, clear and timely communication during highu2011pressure provider interactions, and the ability to develop a highu2011performing inu2011state team that prevents regulatory escalation, strengthens provider relationships, and executes on a complex adequacy and risk landscape. Essential Job Duties u2022 Supports executive strategy development, vision and direction for the network function. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. u2022 Hires, trains, manages and evaluates team member performance - provides coaching, development, and recognition; ensures ongoing appropriate staff training, holds regular team meetings, and drives communication and collaboration. u2022 Develops and sustains a high-performance team, dedicated to best in class solutions; responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives. u2022 Develops and implements provider network and contract strategies - identifying specialties and geographic locations to concentrate resources for the purpose of establishing a sufficient network of participating providers to serve the health care needs of Molina's membership and meet established financial goals. u2022 Develops and maintains a market-specific provider reimbursement strategy consistent with reimbursement tolerance parameters (across multiple specialties/geographies); oversees the development of new reimbursement models, and obtains input from corporate and legal on new reimbursement models. u2022 Develops and maintains a system to track contract negotiation activity on an ongoing basis throughout the year; utilizes and oversees departmental training on the contract management system. u2022 Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines related to contracting with physicians, hospitals, and other health care providers. u2022 Contributes as a key member of the senior leadership team and other committees; responsible to address the strategic goals of the department and organization. u2022 Oversees the maintenance of all provider contract information, provider contract templates and ensure that all contracts negotiated can be configured in the QNXT system; collaborates with legal and corporate on an as needed basis to modify contract templates to ensure compliance with all contractual and/or regulatory requirements. u2022 Oversees plan-specific fee schedule management. u2022 Develops strategies to improve EDI/MASS rates. u2022 Provides oversight of provider services and coordinates activities with provider associations and joint operating committee (JOC) leadership. u2022 Provides accountability for the delegation oversight function in the plan. u2022 Provides oversight of the provider network administration area including: provider information management and business analyses of contracts and benefits to support accurate configuration for claims payment. u2022 Oversees all provider/member problem prevention, research and resolution, and provides oversight of the provider/member appeals and grievance process. u2022 Coordinates with enrollment and retention teams to ensure sustainable growth Required Qualifications u2022 At least 12 years experience in health care to include experience in provider network management/contracting, health care operations, and/or government-sponsored programs, and at least 10 years of senior level network operations experience, or equivalent combination of relevant education and experience. u2022 At least 7 years management/leadership experience. u2022 Extensive experience in the health insurance industry. u2022 Track record of strong relationships with hospitals, provider groups, and independent physician associations (IPAs). u2022 Expert level knowledge regarding reimbursement methodologies across all lines of business (Medicaid, Medicare, Marketplace). u2022 Strong experience with various managed health care provider compensation methodologies. u2022 Excellent negotiation and relationship building capabilities. u2022 Demonstrated adaptability and flexibility to changes and response to new ideas and approaches. u2022 Superior interpretation and research skills in order to readily identify problems, get to the root-cause and achieve prompt issue/problem resolution. u2022 Ability to navigate complex regulatory environments. u2022 Data-driven decision-making skills, and strong analytical abilities. u2022 Strong organizational skills and attention to detail. u2022 Ability to work cross-functionally with internal/external stakeholders in a highly matrixed organization, and influence business decisions. u2022 Ability to manage multiple tasks and deadlines effectively. u2022 Strong project management skills. u2022 Excellent verbal and written communication skills, and ability to present at an executive level. u2022 Microsoft Office suite and applicable software programs proficiency. Preferred Qualifications u2022 Deep experience with Medicaid, Medicare, and Marketplace managed care plans. 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 Pay Range: $186,201.39 - $320,000 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-02-13