Marketplace Network Strategy Director (Western Region) - REMOTE
Molina Healthcare Job ID 2026130Job Summary
This Program Director is responsible for managing the Marketplace provider contracting process for Molina Healthcare in the Western regions (ie. CA, WA, NV, AZ). The Marketplace Program Director leads the Marketplace’s provider strategy, while developing and maintaining strong and consistent relationships with assigned health plan markets.
This role manages key provider relationships through health plan partners (Plan Presidents, local contract leader, etc) and demonstrate comprehensive knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape. Co-create and/or oversee the development and management of Molina’s internal Marketplace rate approval process that meets internal operational standards.
KNOWLEDGE/SKILLS/ABILITIES
- Assist the health plans with interpreting eligibility and reimbursement queries as well as relevant data requests
- Routinely communicate organizational policies, procedures, processes, regulatory updates, anticipate and respond to Provider/health plan educational needs and conduct Provider/health plan trainings
- Understand Marketplace’s contracting system(s) to draft, monitor, and maintain the provider contracting department’s SOPs, policies, job aides, and act as a SME to support the training of designated users on how to load, update, maintain, and pull reports from the contracting database(s)
- Industry experience and knowledge of industry standard fee schedules and timing of standard fee schedule updates
- Manages strategic positioning for Marketplace provider contracting, develops networks and identifies and acts upon opportunities for greater value-orientation and risk arrangements
- Identify and manages initiatives that improve medical cost and quality
- Maintain a professional and courteous demeanor in all interactions with customers and internal stakeholders while driving structure and organization
- May engage and oversee the work of external vendors
JOB QUALIFICATIONS
Required Education
Bachelor's degree or equivalent combination of education and experience
Required Experience
7-9 years of healthcare provider contracting and strategy experience, and a strong understanding of healthcare industry regulations
Experience with contract management software and negotiation techniques
Preferred Education
Graduate Degree or equivalent combination of education and experience
Preferred Experience
10+ years
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.
#PJCorp
#LI-AC1
Pay Range: $72,370.82 - $156,803.45 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 05/21/2024ABOUT OUR LOCATION
View Map- Healthplan Enrollment Operations (834 EDI file experience) Sr BA United States, Bowling Green Kentucky, Covington Kentucky, Florence Kentucky, Georgetown Kentucky, Lexington-Fayette Kentucky, Louisville Kentucky, Nicholasville Kentucky, Owensboro Kentucky, Richmond Kentucky 05/30/2024
- Care Review Clinician, Inpatient Review (RN) 9AM to 6PM CENTRAL United States, Kentucky 06/06/2024
- Care Review Clinician, Inpatient Review (RN) 11AM to 8PM CENTRAL United States, Kentucky 06/06/2024
- Specialist, Medicare Member Engagement (Remote - Candidate must reside in California) California, Long Beach California 06/06/2024
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs