VP, Network Strategy & Services - Mississippi Health ...

JOB DESCRIPTION Job Summary Provides executive strategy and leadership to team responsible for provider network management, provider relations, and contracting activities. Leads network strategy and development with respect to adequacy, financial performance, and operational performance. Develops network standards and resources designed to enable Molina to establish and maintain distinct high-performing networks of compassionate and culturally sensitive providers aligned with Molina's mission, vision and values. This role supports a strong, experienced team and requires someone who can move quickly, make sound decisions, and negotiate complex, highu2011visibility contracts with hospitals and providers. Candidate must reside in Mississippi. 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 Develops and implements provider network and contract strategies in new Molina markets - 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 strategies consistent with reimbursement tolerance parameters (across multiple specialties/geographies). u2022 Oversees the development of new reimbursement models; facilitates communication, oversight and approval processes for health plan exceptions for all lines of business. Develops and enhances the provider network management and operations function including the implementation of standard processes, policies and procedures. u2022 Develops a standardized provider engagement u201ctool kitu201d, training program and deployment plan.; develops and implements approaches to determining outcomes of tools and training programs. u2022 Collaborates closely with health plans leadership to ensure compliance with all Molina, regulatory and industry standards. u2022 Supports and executes new health plan implementations, acquisitions and expansions in collaboration with the business development team. u2022 Collaborates with senior leadership, health plan leadership, and collaborating functions to develop and implement provider contracting strategies and provider service strategies to contain unit cost, improve member access and enhance provider satisfaction enterprise-wide. u2022 Develops and oversees deployment strategy and monitoring for u201cprovider profilesu201d and u201cpay-for-performance (P4P)u201d contracting. u2022 In conjunction with provider services and provider contracting leaders in the health plans and within the corporate function, develops and implements approaches for performance management of value-based reimbursement. u2022 Develops and refines u201cclear coverageu201d provider adoption strategies and assists in training of health plan staff as clear coverage is implemented in each plan. u2022 Represents provider engagement with stakeholder experience, quality and RAMP business partners to ensure incorporate of necessary plans to achieve positive operational and financial outcomes. u2022 Develops and maintains a system to track contract negotiation activities; facilitates health plan implementation, utilization, compliance, and develops and delivers enterprise-wide training for the contract management system. u2022 Develops and authors all enterprise contract templates in conjunction with legal; disseminates templates, and maintains and updates to include state regulatory changes, operational business objectives and financial terms; maintains language libraries for the enterprise. u2022 Directs the strategy, preparation and negotiations of national provider contracts across the enterprise; oversees negotiation of national contracts in concert with established company templates and guidelines with vendors, physicians, hospitals, and other health care providers. u2022 Monitors key metrics to determine provider engagement effectiveness and success (e.g. provider appeals and grievances, member appeals and grievances, Consumer Assessment of Healthcare Providers and Systems (CAHPs), STAR ratings, Healthcare Effectiveness Data Information Set (HEDIS), HEP completion Rates, etc.) u2022 Leads and manages the development and implementation of activities for network development and contracting projects. u2022 Directs the evaluation, review, and negotiation processes for network development projects. u2022 Supports business development and new business implementation engagements across markets, taking into consideration individual market circumstances, provider community, budget guidelines and available resources. u2022 Completes negotiations with complex and major provider contracts as needed to support network objectives. u2022 Leads the network development and contracting teams during the development and implementation stages. u2022 Monitors performance in accordance with Molina standards and guidelines; communicates with senior leadership and other Molina leaders regarding network strategy and planning. u2022 Contributes as a key member of the corporate network leadership team. 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. Required Qualifications u2022 At least 12 years of 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 of 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 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. #PJHPO #LI-AC1 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 - $363,093 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2026-03-09